Dermohypodermite bactérienne nécrosante (DHBN) avec atteinte musculaire à Clostridium septicum révélatrice d'un cancer du côlon

Crousier, M.; Delmas, J.; Blanchet, Marie-Cécile; Lepape, Alain; Perdrix, Jean; Gueugniaud, Pierre‐Yves

doi:10.1016/j.annfar.2005.01.013

Cited by 2 publications

(1 citation statement)

References 11 publications

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“…C. septicum is known to be one of the agents Fig. 1 Abdominal computed tomography scan showing pneumoperitoneum and the presence of gas in the colonic wall and portal vein of gangrenes [1,2] and myonecrosis in immunosuppressed patients [3]. A strong correlation between C. septicum bacteremia and digestive cancers is classical.…”

Section: To the Editormentioning

confidence: 99%

A Fulminant Enterocolitis

et al. 2007

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A 54-year-old woman was referred to the intensive care unit (ICU) for shock and abdominal pain. There was a 4-month history of localized breast cancer treated by surgery and chemotherapy. Her performance status was not altered. The last course of chemotherapy (adriamycin and taxol) had been administered 10 days before. Abdominal pain, located initially in the right lower quadrant, and chills began 12 hr before ICU admission. Four hours after abdominal pain occurrence, the patient was oriented and had no circulatory or respiratory distress but presented with mild abdominal discomfort. There was neither diarrhea nor vomiting and nausea. Rectal temperature was 40 • C, and heart rate was 115 bpm. The abdomen was painful and slightly distended, without tenderness. Bowel sounds were rare and rectal examination was negative. White cell count was 200/µl. An abdominal x-ray and an ultrasound examination did not disclose any abnormalities. Blood cultures were drawn and intravenous ceftazidime (2 and 6 g/day) plus amikacine (25 mg/kg once a day) was started. Four hours before ICU admission, mild hypotension occurred, responding initially to administration of intravenous fluid. Two hours before ICU admission, confusion, recurrence of hypotension, and increased abdominal pain motivated ICU referral. The patient was obtunded but answered questions. Blood pressure was 81/36 mm Hg, and pulse rate was 126 bpm. Mottling was observed on the knees and the abdominal wall. Intravenous isotonic saline, norepinephrine, piperillin/tazobactam, 4 g/qid 6 hr, and ornidazole, 1 g/day, were administered. Abdominal computed tomography scan showed pneumoperitoneum and the presence of gas in the colonic wall and portal vein (Fig. 1). Emergent laparotomy were performed. The abdominal cavity contained serosanguinous liquid, and there was extensive digestive necrosis involving the last meter of the ileum, the right colon, and the terminal part of the left colon. Despite supportive care and large bowel resection, the patient died 36 hr after ICU admission.Histological examination showed necrosis of the wall of the ileum and right colon. Bacteriological examination showed Gram-positive rods. Culture yielded Clostridium septicum, producing lethal toxin for mouse. PCR amplification detected the gene encoding for the lethal toxin of C. septicum. C. septicum is known to be one of the agents Fig. 1 Abdominal computed tomography scan showing pneumoperitoneum and the presence of gas in the colonic wall and portal vein Springer

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Section: To the Editormentioning

confidence: 99%

A Fulminant Enterocolitis

et al. 2007

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An atypical case of necrotizing fasciitis secondary to perforated cecal cancer

Heidelberg

Pettke

Wagner

et al. 2020

Journal of Surgical Case Reports

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Necrotizing fasciitis is an aggressive, life threatening soft tissue infection that requires high index of suspicion for diagnosis. Diagnosis is clinical with management including broad spectrum antibiotics and emergent operative debridement. The majority of cases are secondary to underlying medical processes, local tissue damage, abscess, or inciting procedure, with a paucity of data correlating causation with colon cancer. We describe the case of an 84-year-old man presenting with sepsis of unknown origin who was diagnosed with an atypical presentation of necrotizing fasciitis secondary to a perforated cecal malignancy. His case is unique in that a less virulent polymicrobial infection was likely involved as he initially improved with conservative management alone. He ultimately declined and expired secondary to overwhelming sepsis from his infection. This case highlights the importance of maintaining a high index of suspicion for necrotizing infection and considerations for alternative etiologies of infection including perforated malignancies.

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Dermohypodermite bactérienne nécrosante (DHBN) avec atteinte musculaire à Clostridium septicum révélatrice d'un cancer du côlon

Cited by 2 publications

References 11 publications

A Fulminant Enterocolitis

A Fulminant Enterocolitis

An atypical case of necrotizing fasciitis secondary to perforated cecal cancer

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