Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA.
Am J Case Rep. 2024 Sep 27;25:e944958. doi: 10.12659/AJCR.944958.
BACKGROUND Clostridium ramosum is an anaerobic, spore-producing, gram-positive rod, enteric pathogen that is difficult to identify and is rarely pathogenic. We present a case of Clostridium ramosum bacteremia secondary to aspiration pneumonia in a 65-year-old immunocompromised man on chemotherapy for follicular lymphoma. CASE REPORT We report the case of a 65-year-old man, on active chemotherapy for follicular lymphoma, presenting with a fever of 38.3°C, nonproductive cough, fatigue, and confusion. Physical examination was unremarkable except for +2 lower-extremity pitting edema. CT abdomen pelvis showed left lower-lung consolidation and CT chest angiogram showed that the consolidation was concerning for infarct verses abscess and segmental/subsegmental pulmonary emboli despite anticoagulation use. Blood cultures later grew Clostridium ramosum, which was successfully treated with IV piperacillin-tazobactam. Subsequent outpatient imaging demonstrated resolution of the lung consolidation. CONCLUSIONS Our case highlights the rare diagnosis of Clostridium ramosum bacteremia secondary to aspiration pneumonia in an immunocompromised patient and our approach to management. We highlight the difficulties in identification of Clostridium ramosum, rare pathogenicity, risk factors, and potential sources.
脆弱拟杆菌是一种厌氧、产芽孢、革兰阳性杆状、肠道病原体，难以识别，很少致病。我们报告了一例因吸入性肺炎导致脆弱拟杆菌血症的病例，患者为 65 岁免疫功能低下男性，正在接受滤泡淋巴瘤的化疗。
我们报告了一例 65 岁男性病例，正在接受滤泡淋巴瘤的化疗，表现为发热 38.3°C、无痰咳嗽、疲劳和意识模糊。除了下肢 +2 级凹陷性水肿外，体格检查无明显异常。腹部盆腔 CT 显示左下肺实变，胸部 CT 血管造影显示，尽管使用了抗凝药物，但实变仍考虑为梗死而非脓肿和节段/亚段肺栓塞。血培养后来培养出脆弱拟杆菌，静脉注射哌拉西林他唑巴坦成功治疗。随后的门诊影像学检查显示肺部实变消退。
我们的病例强调了免疫功能低下患者因吸入性肺炎导致脆弱拟杆菌血症的罕见诊断以及我们的治疗方法。我们强调了识别脆弱拟杆菌的困难、罕见的致病性、危险因素和潜在来源。
