Clostridium septicum-infected Stanford type A acute aortic dissection: a case report

Abstract

Background: Thoracic aortitis caused by Clostridium septicum is a rare infection with a strong association with malignancy and high mortality rate when left untreated. We report a case of surgical treatment for Stanford type A acute aortic dissection in a patient with C. septicum sepsis and thoracic aortitis. Case presentation: A 63-year-old hypertensive man with rheumatoid arthritis presented with general malaise and diagnosed with C. septicum-infected aortitis with sepsis. On the 5th day of hospitalization, Stanford type A acute aortic dissection developed with severe aortic regurgitation. The patient underwent emergent surgical treatment successfully with excision of the infected ascending aorta and aortic root followed by replacement using a composite graft, followed by diagnosis of sigmoid colon cancer 7 months after aortic surgery. He was scheduled to undergo elective colon surgery. Conclusions: C. septicum aortitis can progress quickly, causing aneurysm or dissection. Therefore, in a patient with C. septicum aortitis, prompt surgical in situ graft replacement should be performed to debride the infected vascular lesions. Further investigations for gastrointestinal and hematological malignancies as a source of C. septicum should be also conducted.

Prospects of conservative treatment for Clostridium septicum–associated aortitis

“…Our literature search in August 2021 revealed a total of 72 cases of C. septicum –associated aortitis. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 Thus, the case we have presented is case number 73. Demographically, we found a predisposition for male sex (66.2%), older age (median, 76 years; interquartile range, 67-82 years), gastrointestinal malignancies (52.1%), and diabetes (22.5%).…”

“…Antibiotic treatment as the only conservative approach was administered to 23 patients compared with 39 patients who had undergone OAR, 5 patients who had undergone EVAR, and 5 patients whose further treatment was not specified. 14 , 18 , 20 , 21 , 22 , 23 However, to date, the 6-month mortality was 100% for patients receiving conservative treatment (90-day mortality, 84.2%), in contrast to 43.2% for patients undergoing surgery (90-day mortality, 32.1%). 2 , 13 , 16 , 17 , 19 , 21 Regarding OAR, long-term survival (>1 year) was reached for 25% to 50% of patients.…”

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

“…C. septicum is a major etiological agent of nontraumatic or spontaneous gas gangrene, a fulminant form of myonecrosis, in humans (38). The incidence and epidemiology of C. septicum infection in humans is unknown; however, on the basis of case reports, the bacterium can cause aortitis (53)(54)(55)(56)(57)(58), pneumorachis (59,60), meningitis (61), and hepatic abscess (62). These infections can lead to gas gangrene, and even septicemia, with a mortality rate of up to 79% within 48 hours (34).…”

A case of clostridium septicum aortitis

“…Infective aortitis can be caused by a number of different organisms, of which Clostridium septicum is one of the least common, 1 but perhaps one of the most virulent. A review of all reported cases of C. septicum aortitis demonstrated this to be the 73rd reported case 2–7 …”

“…A review of all reported cases of C. septicum aortitis demonstrated this to be the 73rd reported case. [2][3][4][5][6][7] C. septicum is a Gram-positive, spore-forming rod, with a strong predisposition to spread throughout the body both via local and haematogenous distribution. 8 Aortic involvement is associated with colonic carcinoma in up to 56%, 2 as its anaerobic growth is facilitated by the hypoxic, necrotic milieu of the tumour.…”