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

Abstract

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.

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

“…We read with interest the well-written report by Ghanouni et al regarding their patient with endogenous Clostridium septicum panophthalmitis. 1 This case was reminiscent of our experience with a patient who presented with fulminant C. septicum bacteremia and panophthalmitis as the initial manifestation of occult colon adenocarcinoma, 2 as well as a previously reported case of C. septicum bacteremia and panophthalmitis of presumed gastrointestinal tract origin. 3 Neither patient had an underlying hematologic malignancy.…”

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

“…We thank Dr. Woog and Dr. Destro for reading our report and bringing additional cases of this rare entity to our attention. 1–3 This is further evidence that patients with gastrointestinal malignancies are high risk for C. septicum infections, which can affect the eye. We also agree that normal screening protocols are of utmost importance in the prevention and early diagnosis of such cancers and should not be disrupted during the COVID-19 pandemic.…”