Clostridium septicum growth from a total knee arthroplasty associated with intestinal malignancy: a case report

Abstract

BackgroundPrevious reports of infection with Clostridium septicum have identified an unexpected association with concurrent malignancy. The reported rate of associated malignancy has been found to be as high as 81 percent. The purpose of this case report was to present a case of a total knee arthroplasty infected with C. septicum and the subsequent finding of an occult colonic malignancy.Case presentationA 74 year-old man underwent uneventful bilateral total knee arthroplasties. Two weeks post-operatively, he presented with acute swelling, redness and pain of the left knee. Aspiration of the knee was sent for cell count and culture. The cell count demonstrated 39,000 white blood cells per cubic millimeter with 71% of white blood cells identified as neutrophils. Synovial fluid cultures identified the presence of C. septicum, Enterobacter and coagulase negative Staphylococcus. After urgent irrigation and debridement and polyethylene exchange of the affected knee, the patient was placed on intravenous Penicillin G for a period of six weeks. Two weeks into his course of antibiotics, the patient developed hematochezia and was found to have an obstructive colonic malignancy. The patient underwent hemi-colectomy and has since made a complete recovery of both his malignancy and total knee arthroplasty infection.ConclusionRecognition of the association between C. septicum and malignancy is especially important considering the large predicted increase in total joint arthroplasty procedures over the coming decades. In addition to the standard treatment for infection after total joint arthroplasty, identification of Clostridium septicum should initiate a search for associated occult malignancy.

Anaerobic prosthetic joint infection

“…No specific site of involvement appears to be uniquely associated with Clostridium PJI, as there are cases reported involving hip, knee and shoulder arthroplasties [14,35,75]. A few case reports have outlined the presence of concomitant microorganisms associated with these infections, including coagulase negative Staphylococcus species [14,33], as well as Enterobacter species [33].…”

“…There are also reports of PJI due of Clostridium septicum and Clostridium cadaveris. Clostridium PJI tends to present early, within three months after the initial implantation of hardware [12,14,33,74], but may also present later on [11,35,75]. There are a limited number of case reports outlining the clinical features of Clostridium PJI; localized tenderness, redness, swelling and warmth were present in the majority of patients [11e14, 19,32,33,35,74e76].…”

Prosthetic Joint Infection

“…In contrast to other anaerobic infections, which may exist as part of a polymicrobial infection (170,186), infections due to Actinomyces species are nearly uniformly monomicrobial (191)(192)(193)(194)(195). The clinical presentation is typically indolent, as in other Actinomyces infections.…”

“…Similar to S. gallolyticus subsp. gallolyticus, there is an association between Clostridium septicum PJI and intestinal malignancy (185,186). Clostridium perfringens PJI has been identified following acute cholecystitis (187).…”

Growth Inhibitory Activity of Kakadu Plum Extracts Against the Opportunistic Pathogenclostridium Perfringens: New Leads in the Prevention and Treatment of Clostridial Myonecrosis.

“…Though it is caused by a number of species within the Clostridium genus (including C. septicum, C. histolyticum or C. novyi), the predominant cause of gas gangrene is through C. perfringens, which is estimated to be the causative agent in 80-90% of all documented cases. 4,5 The bacterium is reliant on anaerobic conditions and thus infection occurs primarily in deep tissues, either as a result trauma or postsurgery. 6 Associated exotoxins are subsequently produced and these necrotize the surrounding tissue, resulting in muscular degradation.…”