title: Osteomyelitis due to Clostridium innocuum in a patient with acute lymphoblastic leukemia: case report and literature review.
abstract: BACKGROUND
  Clostridium innocuum is an anaerobic Gram-positive bacterium, unable to produce toxins and rarely causes infections. We report the first case of C. innocuum osteomyelitis and bacteremia in a patient with acute lymphoblastic leukemia (ALL). Findings were compared with previously reported cases of C. innocuum infections in immunocompromised patients, e.g., patients with acquired immune deficiency syndrome, leukemia, and organ transplantation.
  
  
  METHODS
  A 32-year-old Japanese male was admitted for persistent low-grade fever and purpura lasting for 1 month. Complete blood counts and cytogenetic analysis identified Ph1-positive ALL, which was successfully treated using chemotherapy. However, the patient developed high fever and lumbar pain during complete remission. Fluorodeoxyglucose-positron emission tomography and computed tomography demonstrated osteomyelitis. C. innocuum was identified as the causative agent and the patient was successfully treated using antibiotic therapy.
  
  
  RESULTS
  We performed a literature review revealing a number of common aspects to the clinical presentation of C. innocuum infection and an association with various comorbidities. Further, we highlight the most efficient diagnostic and treatment strategies for C. innocuum osteomyelitis.
  
  
  CONCLUSIONS
  Clostridium innocuum can be a causative pathogen of osteomyelitis and bacteremia in immunocompromised patients.
authors.affiliation: Division of Hematology, Department of Internal Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655 Japan ; Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655 Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Mutoh
authors.affiliation: Division of Hematology, Department of Internal Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655 Japan.
authors.forename: Risen
authors.initials: R
authors.lastname: Hirai
authors.affiliation: Division of Hematology, Department of Internal Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655 Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Tanimura
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655 Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Matono
authors.affiliation: Department of Respiratory Diseases, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Eriko
authors.initials: E
authors.lastname: Morino
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655 Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kutsuna
authors.affiliation: Department of Infectious Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Nagamatsu
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655 Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Ohmagari
authors.affiliation: Division of Hematology, Department of Internal Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655 Japan.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Hagiwara
keywords: Acute lymphoblastic leukemia; Clostridium innocuum; Direct 16S-rRNA sequencing; Neutropenic enterocolitis; Osteomyelitis