title: Ischaemic stroke and Clostridium septicum sepsis and meningitis in a patient with occult colon carcinoma - a case report and review of the literature.
abstract: BACKGROUND
  Clostridium septicum is a rare cause of meningitis and brain abscess in children and adults. Gas production by the pathogen can lead to pneumocephalus and the overall mortality rate of Clostridium septicum CNS infection is as high as 74%. The most common entry site of the pathogen is the gastrointestinal tract.
  
  
  METHODS
  We describe a 74-year-old man who presented with a left-sided cerebral infarction in the middle cerebral artery territory. In addition the patient showed signs of Systemic Inflammatory Response Syndrome and Disseminated Intravascular Coagulation. Examination of blood cultures and cerebrospinal fluid led to the diagnosis of sepsis and meningitis caused by Clostridium septicum. Despite appropriate antibiotic therapy the condition of the patient deteriorated rapidly and he died on day 2 after admission. Autopsy revealed a previously unknown adenocarcinoma of the colon ascendens as entry site of the pathogen.
  
  
  CONCLUSIONS
  Clostridium septicum should be considered as potential pathogen in patients with sepsis and meningitis. Gram stain morphology in conjunction with severe sepsis can rapidly point into the direction of this pathogen. CNS infections manifest either as meningoencephalitis/cerebritis or as brain abscess. Entry site of the pathogen is almost uniquely the gastrointestinal tract. In adults more than 50% suffer from colorectal carcinoma, therefore survivors of Clostridium septicum infections should be examined for underlying occult colorectal malignancy.
authors.affiliation: Department of Neurology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: Kosmas
authors.initials: K
authors.lastname: Macha
authors.affiliation: Department of Neurology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Giede-Jeppe
authors.affiliation: Department of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Lücking
authors.affiliation: Department of Neuropathology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Coras
authors.affiliation: Department of Neurology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: Hagen B
authors.initials: HB
authors.lastname: Huttner
authors.affiliation: Mikrobiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Wasserturmstraße 3-5, 91054, Erlangen, Germany. juergen.held@uk-erlangen.de.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Held
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D000368:Aged; D003015:Clostridium Infections / Q000175:diagnosis*; D052557:Clostridium septicum / Q000472:pathogenicity*; D003110:Colonic Neoplasms / Q000175:diagnosis*; D017809:Fatal Outcome; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis*; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis*; D018805:Sepsis / Q000175:diagnosis*
keywords: Bacteremia; CNS infection; Cerebritis; DIC; Ischemic stroke; Meningoencephalitis; Pneumocephalus; Sepsis