title: Fatal spontaneous Clostridium septicum gas gangrene: a possible association with iatrogenic gastric acid suppression.
abstract: The long-term use of proton pump inhibitors has been linked to an increased risk for the development of gastric polyps, hip fractures, pneumonia, and Clostridium difficile colitis. There is evidence that chronic acid suppression from long-term use of proton pump inhibitors poses some risk for the development of C difficile-associated diarrhea by decreasing the elimination of pathogenic microbes before reaching the lower gastrointestinal tract. Here we present a case of a 51-year-old woman with a recent history of abdominal pain and fever who presented to the emergency department with rapidly progressive spontaneous necrotizing fasciitis and gas gangrene and died within hours of presentation. Postmortem examination confirmed spreading tissue gas gangrene and myonecrosis. In addition, multiple intestinal ulcers containing Clostridium septicum were present at autopsy. This case illustrates a possible association between proton pump inhibitor therapy and fatal C septicum infection.
authors.affiliation: From Johns Hopkins School of Medicine, Baltimore, Maryland (Ms Wu); and the Department of Pathology (Drs Baras, Cornish, Riedel, and Burton), Johns Hopkins Medicine, Baltimore, Maryland.
authors.forename: Yiru E
authors.initials: YE
authors.lastname: Wu
authors.forename: Alexander
authors.initials: A
authors.lastname: Baras
authors.forename: Toby
authors.initials: T
authors.lastname: Cornish
authors.forename: Stefan
authors.initials: S
authors.lastname: Riedel
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Burton
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D052557:Clostridium septicum / Q000472:pathogenicity; D019115:Fasciitis, Necrotizing / Q000209:etiology / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D005738:Gas Gangrene / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007049:Iatrogenic Disease; D007082:Ileum / Q000473:pathology; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000009:adverse effects
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors