Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
BMC Infect Dis. 2023 Mar 30;23(1):189. doi: 10.1186/s12879-023-08160-9.
Disseminated Clostridium septicum infection is an uncommon complication associated with malignancies, particular colonic adenocarcinoma. The organism appears to preferentially colonize large masses in rare individuals and subsequently seed the blood via mucosal ulceration. This has rarely been reported to lead to central nervous system infection and, in several cases, rapidly progressive pneumocephalus. In the few cases reported, this was a universally fatal condition. The current case adds to the reports of this extremely rare complication and provides a unique and complete clinicopathologic characterization with autopsy examination, microscopy, and molecular testing.
A 60-year-old man with no known past medical history was discovered having seizure-like activity and stroke-like symptoms. Blood cultures turned positive after six hours. Imaging revealed a large, irregular cecal mass as well as 1.4 cm collection of air in the left parietal lobe that progressed to over 7 cm within 8 h. By the following morning, the patient had lost all neurologic reflexes and died. Post-mortem examination revealed brain tissue with multiple grossly evident cystic spaces and intraparenchymal hemorrhage, while microscopic exam showed diffuse hypoxic-ischemic injury and gram-positive rods. Clostridium septicum was identified on blood cultures and was confirmed in paraffin embedded tissue from the brain by 16 S ribosomal sequencing and from the colon by C. septicum specific PCR.
C. septicum is an anaerobic, gram-positive rod that can become invasive and is strongly associated with gastrointestinal pathology including colonic adenocarcinomas. Central nervous system infection with rapidly progressive pneumocephalus is a rarely reported and universally fatal complication of disseminated C. septicum infection.
梭状芽胞杆菌感染的扩散是一种罕见的并发症，与恶性肿瘤，特别是结肠腺癌有关。该病原体似乎更喜欢在罕见的个体中定植于大的肿块，并通过黏膜溃疡随后在血液中播种。这很少导致中枢神经系统感染，并在几种情况下迅速导致气颅。在少数报道的情况下，这是一种普遍致命的情况。目前的病例增加了对这种极其罕见并发症的报道，并提供了独特而完整的临床病理特征，包括尸检检查、显微镜检查和分子检测。
一名 60 岁的男子，无已知既往病史，被发现有癫痫样活动和中风样症状。血液培养在六小时后转为阳性。影像学显示一个大的、不规则的盲肠肿块，以及左顶叶 1.4 厘米的空气积聚，在 8 小时内进展到超过 7 厘米。到第二天早上，患者失去了所有的神经反射，死亡。尸检显示脑组织有多个明显的囊性空间和脑实质内出血，而显微镜检查显示弥漫性缺氧缺血性损伤和革兰阳性杆菌。血液培养中发现梭状芽胞杆菌，并通过 16S 核糖体测序在脑组织石蜡包埋组织中以及通过梭状芽胞杆菌特异性 PCR 在结肠中得到确认。
梭状芽胞杆菌是一种厌氧的革兰阳性杆菌，可变得侵袭性，并与包括结肠腺癌在内的胃肠道病理学密切相关。迅速进展的气颅性中枢神经系统感染是梭状芽胞杆菌感染扩散的罕见且普遍致命的并发症。
