We present the case of a patient, with previously unknown liver metastases, presenting with a liver abscess and Clostridium septicum septicaemia. C. septicum is known to be associated with both malignancy and immunosuppression and therefore in patients where this organism is isolated, efforts must be made to exclude an occult underlying malignancy or haematological disorder

AA Kornbluth

Azhar A Khan

C-H Lee

CM Larson

JG Caya

Kim Davenport

M Sebald

ME Kolbeinsson

MR Katlic

TM Pelfry

English

PubMed

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A reminder of the association between Clostridium septicumand colonic adenocarcinoma

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BioMed Central
International Seminars in Surgical 
Oncology
ssOpen AcceCase report
A reminder of the association between Clostridium septicum and 
colonic adenocarcinoma
Azhar A Khan* and Kim Davenport
Address: Department of surgery, Stafford General Hospital, Weston Road, Stafford, ST16 3SA, UK
Email: Azhar A Khan* - docazhar@gmail.com; Kim Davenport - DrKimDav@aol.com
* Corresponding author    
Abstract
We present the case of a patient, with previously unknown liver metastases, presenting with a liver
abscess and Clostridium septicum septicaemia. C. septicum is known to be associated with both
malignancy and immunosuppression and therefore in patients where this organism is isolated,
efforts must be made to exclude an occult underlying malignancy or haematological disorder.
Introduction
Severe infection with Clostridium septicum in healthy
humans is relatively rare. The organism used to be a well
known complication of war wounds in the form of gas
gangrene [1]. C. septicum can cause other rigorous focal or
disseminated infections by spontaneous invasion from
the gut of compromised patients. C. septicum produces
exotoxin which is responsible for rapid progression of
infection. Exotoxin hydrolyses cell membranes, causes tis-
sue necrosis by inducing occlusive microvascular throm-
bosis. These spontaneous forms of infection are believed
to be associated with colonic malignancy (especially in
the cecum) [2], acute leukemia or cyclical neutropenia [3].
Unlike C perfringens, C septicum is aerotolerant and can
infect normal tissues. We are reporting this recent case as
a reminder of this association and to re-emphasise the
importance of investigating these patients for occult
malignancy.
Case report
A 59 year old gentleman presented with a 3 day history of
right upper quadrant pain radiating into the right shoul-
der. His only past medical history was hypertension. On
examination, he was jaundiced with a temperature of
38.2°C, pulse 120 and a blood pressure of 130/80. He
was found to have tender hepatomegaly. His blood results
showed an anaemia of 9.6, mild renal impairment (urea
11.9, creatinine 142) and hepatic impairment (Bilirubin
60, AST 274, alkaline phosphatase 170). An X-Ray [figure
1] revealed multiple gas filled lesions within the right
upper quadrant of the abdomen which were confirmed
on ultrasound as originating in the liver.
CT [figure 2] revealed the presence of a central core of
irregular soft tissue in the liver, which was thought to be
an abscess. A drain was inserted under ultrasound guid-
ance. Both the blood cultures and drainage fluid grew
Clostridium septicum. He proceeded to have an ultrasound-
guided biopsy of the central soft tissue core. Histology
confirmed a necrotic metastatic adenocarcinoma with
morphology consistent with a colorectal origin. Immuno-
histochemistry further supported this assumption as
cytokeratin 7 was negative and both cytokeratin 20 and
CEA were positive. Serum tumour markers revealed an
elevated CEA (14) and CA19-9 (66).
Published: 28 April 2006
International Seminars in Surgical Oncology2006, 3:12 doi:10.1186/1477-7800-3-12
Received: 20 February 2006
Accepted: 28 April 2006
This article is available from: http://www.issoonline.com/content/3/1/12
© 2006Khan and Davenport; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 3
(page number not for citation purposes)
International Seminars in Surgical Oncology 2006, 3:12 http://www.issoonline.com/content/3/1/12Discussion
Clostridium septicum is an anaerobic, gas forming, gram-
positive bacillus. It is thought to be an intestinal commen-
sal in man and animals. It is believed that the caecum and
terminal ileum provide the most favourable environment
for colonisation. The presence of mucosal barrier disrup-
tion, for example, mucosal ulceration secondary to malig-
nancy, ischaemia or chemoradiotherapy, is thought to
allow invasion into the blood stream. The gastrointestinal
tract is the presumed portal of entry in the majority of
cases.
Infections with this organism are rare but are associated
with serious outcomes with a mortality of up to 45–70 %.
It produces marked toxicity and may present as gas gan-
grene, myonecrosis, sepsis or liver abscesses. C. septicum is
rarely able to cause liver abscesses in the absence of any
underlying pathology [4]. Most typically the underlying
lesion is a metastasis, which has outgrown its blood sup-
ply and therefore provides an ideal anaerobic environ-
ment for bacterial growth. The gas produced by the
organism appears to remain limited to the area of metas-
tases and does not invade adjacent healthy tissue [4] so
causing generalised liver enlargement. To the best of our
knowledge, this organism has not been reported with pri-
mary liver carcinoma in the literature.
There is a known association between C. septicum and
immunosuppression or malignancy, most commonly of
colonic or haematological origin, although there are
reported cases in association with choriocarcinoma [5]
and breast carcinoma [6] in the literature. In one study [7]
looking at all Clostridial infections, 11% were secondary to
C. septicum, an associated malignancy was found in 50%
(as compared to 11% of patients with other clostridial
infections) and the remaining patients all had evidence of
immunosuppression. There was 56% mortality with C.
septicum as opposed to 26% with other strains. In
another [8], 87.5% of cases were found to have malig-
nancy, 86% of these originated in the gastrointestinal tract
and the remainder were haematological.
Intravenous antibiotics, predominantly penicillin, remain
the mainstay of treatment, and in some cases, surgical
debridement is necessary.
Conclusion
Those patients found to have C. septicum should undergo
an aggressive search for an underlying malignancy or hae-
matological abnormality if they are fit for further inter-
ventions.
Conflict of interest
The author(s) declare that they have no competing inter-
ests.
References
1. Sebald M, Hauser D: Pasteur, oxygen and the anaerobes revis-
ited.  Anaerobe 1995, 1:11-16.
2. Kornbluth AA, Danzig JB, Bernstein LH: Clostridium septicum
infection and associated malignancy.  Medicine 1989, 68:30-37.
3. Caya JG, Farmer SG, Ritch PS, Wollenberg NJ, Tieu TM, Oechler
HW, Spivey M: Clostridial septicemia complicating the course
of leukemia.  Cancer 1986, 57:2045-2048.
Figure 2
Figure 1Page 2 of 3
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4. Kolbeinsson ME, Holder WD Jr, Aziz S: Recognition, manage-
ment and prevention of Clostridium septicum abscess in
immunosuppressed patients.  Arch Surg 1991, 126:642-645.
5. Lee C-H, Hseih S-Y: Case report: Clostridium septicum infection
presenting as liver abscess in a case of choriocarcinoma with
liver metastasis.  J Gast & Hep 1999, 14(12):1227-1229.
6. Katlic MR, Dervac WM, Coleman WS: Clostridium septicum infec-
tion and malignancy.  Ann Surg 1981, 193(3):361-364.
7. Larson CM, Bubrick MP, Jacobs DM, West MA: Malignancy, mor-
tality and medicosurgical management of Clostridium septi-
cum infection.  Surgery 1995, 118(4):592-598.
8. Pelfry TM, Turk RP, Peoples JB, Elliott DW: Surgical aspects of
Clostridium septicum septicaemia.  Arch Surg 1984,
119(5):546-550.Page 3 of 3
(page number not for citation purposes)


A reminder of the association between and colonic adenocarcinoma

Clostridial septicemia complicating the course of leukemia. Cancer

LH: Clostridium septicum infection and associated malignancy. Medicine

oxygen and the anaerobes revisited. Anaerobe

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A reminder of the association between Clostridium septicum and colonic adenocarcinoma

A reminder of the association between Clostridium septicum and colonic adenocarcinoma

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