Clinic of General, Visceral and Transplant Surgery, Jessenius Faculty of Medicine, Comenius University in Bratislava, University Hospital Martin, Martin, Slovak Republic.
Clinic of Anaesthesiology and Intensive medicine, Jessenius Faculty of Medicine, Comenius University in Bratislava, University Hospital, Martin, Slovak Republic.
Neuro Endocrinol Lett. 2022 Jun 7;43(2):57-64.
Since the second half of the 20th century, an association between the occurrence of Clostridium septicum and Streptococcus gallolyticus infections in patients with colorectal cancer has been described in specialist literature. Infections are manifested by bacteremia, septic embolism, cellulitis, myonecrosis, and gas gangrene of the limbs.
The authors present a case of a rare association between lower limb gangrene caused by the septic embolization of a Clostridium septicum infection and malignancy of colon ascendens in a polymorbid patient. Gangrene of the lower limb led to septic shock requiring acute amputation treatment. After managing the acute condition, the patient was operated on for a malignant colon tumour.
The process of carcinogenesis often takes years and is almost asymptomatic. The occurrence of S. bovis/S. equinus (SBSEC) and C. septicum bacteremia, respectively, is relatively rare, but their presence is often associated with the occurrence of malignancy, most often of the lower gastrointestinal tract. This paraneoplastic symptom may be the first manifestation of a malignant disease. The effect of exotoxins can lead to sepsis or even septic shock with a mortality of 48-56%.
Clostridium septicum and Streptococcus gallolyticus infections are rare in clinical practice. However, their presence can be a first paraneoplastic symptom, and therefore the doctor should look for a possible oncological disease when they are detected. The main diagnostic methods include colonoscopy and imaging, especially CT scan.
自 20 世纪下半叶以来，专家文献中描述了大肠癌患者中梭状芽孢杆菌和鹑鸡肠球菌感染之间的关联。感染表现为菌血症、脓毒性栓塞、蜂窝织炎、肌坏死和四肢气性坏疽。
作者报告了一例罕见的病例，即由梭状芽孢杆菌感染的脓毒性栓塞引起的下肢坏疽与多系统疾病患者的升结肠癌恶性肿瘤之间的关联。下肢坏疽导致脓毒性休克，需要进行急性截肢治疗。在处理急性病情后，对该患者进行了恶性结肠肿瘤手术。
癌变过程通常需要数年时间，且几乎没有症状。牛链球菌/马肠球菌（SBSEC）和梭状芽孢杆菌血症的发生相对较少，但它们的存在通常与恶性肿瘤的发生有关，最常见的是下消化道。这种副肿瘤症状可能是恶性疾病的第一个表现。外毒素的作用可导致败血症，甚至导致死亡率为 48-56%的败血性休克。
梭状芽孢杆菌和鹑鸡肠球菌感染在临床实践中较为罕见。然而，它们的存在可能是第一个副肿瘤症状，因此医生在发现这些感染时应寻找可能的肿瘤疾病。主要的诊断方法包括结肠镜检查和影像学检查，特别是 CT 扫描。
