Clostridium Septicum Endogenous Endophthalmitis as the Initial Manifestation of Colorectal Carcinoma: Clinical Case Report and Literature Review

Sánchez-Vicente, J.L.; Contreras-Díaz, M.; López-Herrero, F.; Martínez-Borrego, A.C.; Galván-Ledesma, Antonio; Lozano-Bernal, O.; García-Vázquez, M; Morenas-Iglesias, J. de las; Caro-Magdaleno, Manuel

doi:10.1080/09273948.2020.1799039

Cited by 6 publications

(9 citation statements)

References 15 publications

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“…However, in several of these cases, blood cultures did not reveal growth at any stage of diagnosis. 3,4 Similarly, in our case, initial blood cultures did not reveal C. septicum. Postulated reasons for negative cultures may include recent antibiotic exposure, sampling error, insufficient volume for blood cultures, poor transport conditions, and slow-growing or fastidious bacteria.…”

Section: Discussionsupporting

confidence: 66%

“…Of the 7 previous studies reported of C. septicum involving the eye and orbit, 4 cases presented with a previously undiagnosed colonic malignancy, and only 1 of those also had an associated undiagnosed hematologic malignancy. 3,4,10,11 Only 2 described cases resulted in an infection serious enough to warrant enucleation. 4,11 Furthermore, the presence of a chiasmal syndrome as a result of inflammation from a unilateral source as seen in our case has not been well described, with only 1 report demonstrating a similar presentation from spread of a uveal melanoma.…”

Section: Discussionmentioning

confidence: 99%

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Occult Colon Adenocarcinoma and Multiple Myeloma Associated With Clostridium septicum Panophthalmitis With Orbital and Chiasmal Extension: A Case Report

Ghanouni

Avila

Kim

2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

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A previously healthy 62-year-old African American female presented with a fulminant orbital cellulitis of the right eye with diffuse scleritis and orbital inflammation extending to the optic chiasm on neuroimaging. She was taken for an emergent orbitotomy with an orbital fat biopsy and started on broad-spectrum intravenous (IV) and topical antibiotics. Within 36 hours of presentation, scleral thinning and a corneal melt ensued, ending in enucleation. Intraoperative cultures were positive for Clostridium septicum, leading to a systemic work-up exposing a previously undiagnosed colon adenocarcinoma and metastatic multiple myeloma.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Occult Colon Adenocarcinoma and Multiple Myeloma Associated With Clostridium septicum Panophthalmitis With Orbital and Chiasmal Extension: A Case Report

Ghanouni

Avila

Kim

2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…They, however, occur in colorectal carcinomas, so a complete systemic study must be performed in these cases to find the origin of the infection (8,9) . In some cases, as in our case, the first manifestation of colorectal carcinoma is panophthalmitis (10) .…”

Section: Discussionsupporting

confidence: 55%

Fulminant endogenous panophthalmitis caused by Clostridium septicum infection

Diaz¹,

González-Oliva²,

Hervás³

et al. 2023

ABO

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We report an unusual case of fulminant endogenous Clostridium septicum panophthalmitis. A 74-year-old male patient presented with sudden amaurosis in right eye, which in a few hours, evolved into an orbital cellulitis, endophthalmitis, anterior segment ischemia, and secondary perforation of the eye. A complete diagnostic study, which included cranial and orbital contrast-enhanced computed tomography scan, contrast-enhanced magnetic resonance imaging, blood cultures, and complete blood work, were performed. No causal agent was identified. Clostridium septicum infection caused fulminant gaseous panophthalmitis. Despite broad-spectrum antibiotic treatment, evisceration of the eyeball was necessary. The extension study showed a colon adenocarcinoma as the origin of the infection. Clostridium septicum panophthalmitis is a rare but aggressive orbital infection. This infection warrants the identification of a neoplastic process in the gastrointestinal tract in many cases not previously described.

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“…Preexisting morbidities, such as gastrointestinal malignancy, diabetes, leukemia, and neutropenia, substantially increase the risk of C. septicum infection ( 32 , 63 ). These underlying clinical manifestations may lead to ulceration of the gastrointestinal mucosa, allowing C. septicum , which normally resides in the intestinal tract, to enter the circulation and establish infection in distal anaerobic sites ( 53 , 58 , 60 , 61 , 64 , 65 ). C. septicum infection may be treated with antibiotics, surgical removal of necrotic tissue, and hyperbaric oxygen therapy ( 29 , 66 ).…”

Section: Discussionmentioning

confidence: 99%

Clostridium septicum α-toxin activates the NLRP3 inflammasome by engaging GPI-anchored proteins

et al. 2022

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Clostridium species are a group of Gram-positive bacteria that cause diseases in humans, such as food poisoning, botulism, and tetanus. Here, we analyzed 10 different Clostridium species and identified that Clostridium septicum , a pathogen that causes sepsis and gas gangrene, activates the mammalian cytosolic inflammasome complex in mice and humans. Mechanistically, we demonstrate that α-toxin secreted by C. septicum binds to glycosylphosphatidylinositol (GPI)–anchored proteins on the host plasma membrane, oligomerizing and forming a membrane pore that is permissive to efflux of magnesium and potassium ions. Efflux of these cytosolic ions triggers the activation of the innate immune sensor NLRP3, inducing activation of caspase-1 and gasdermin D, secretion of the proinflammatory cytokines interleukin-1β and interleukin-18, pyroptosis, and plasma membrane rupture via ninjurin-1. Furthermore, α-toxin of C. septicum induces rapid inflammasome-mediated lethality in mice and pharmacological inhibition of the NLRP3 inflammasome using MCC950 prevents C. septicum –induced lethality. Overall, our results reveal that cytosolic innate sensing of α-toxin is central to the recognition of C. septicum infection and that therapeutic blockade of the inflammasome pathway may prevent sepsis and death caused by toxin-producing pathogens.

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Clostridium Septicum Endogenous Endophthalmitis as the Initial Manifestation of Colorectal Carcinoma: Clinical Case Report and Literature Review

Cited by 6 publications

References 15 publications

Occult Colon Adenocarcinoma and Multiple Myeloma Associated With Clostridium septicum Panophthalmitis With Orbital and Chiasmal Extension: A Case Report

Occult Colon Adenocarcinoma and Multiple Myeloma Associated With Clostridium septicum Panophthalmitis With Orbital and Chiasmal Extension: A Case Report

Fulminant endogenous panophthalmitis caused by Clostridium septicum infection

Clostridium septicum α-toxin activates the NLRP3 inflammasome by engaging GPI-anchored proteins

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