Osteomyelitis due to Clostridium innocuum in a patient with acute lymphoblastic leukemia: case report and literature review

Abstract

IntroductionClostridium innocuum is an anaerobic Gram-positive bacterium, unable to produce toxins and rarely causes infections. We report the first case of C. innocuum osteomyelitis and bacteremia in a patient with acute lymphoblastic leukemia (ALL). Findings were compared with previously reported cases of C. innocuum infections in immunocompromised patients, e.g., patients with acquired immune deficiency syndrome, leukemia, and organ transplantation.Case descriptionA 32-year-old Japanese male was admitted for persistent low-grade fever and purpura lasting for 1 month. Complete blood counts and cytogenetic analysis identified Ph1-positive ALL, which was successfully treated using chemotherapy. However, the patient developed high fever and lumbar pain during complete remission. Fluorodeoxyglucose-positron emission tomography and computed tomography demonstrated osteomyelitis. C. innocuum was identified as the causative agent and the patient was successfully treated using antibiotic therapy.Discussion and evaluationWe performed a literature review revealing a number of common aspects to the clinical presentation of C. innocuum infection and an association with various comorbidities. Further, we highlight the most efficient diagnostic and treatment strategies for C. innocuum osteomyelitis.ConclusionsClostridium innocuum can be a causative pathogen of osteomyelitis and bacteremia in immunocompromised patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-1176-3) contains supplementary material, which is available to authorized users.

First isolation of Clostridium indolis in a patient with chronic osteitis: a case report and literature review of human infections related to Clostridium saccharolyticum group species

“…In addition, Clostridium species are environmental organisms, considered as soil saprophytes, or are part of normal human intestinal flora [20]. Almost all anaerobic osteomyelitis occur by direct extension from an adjacent focus of infection and are rarely due to bacteremia [21]. These data along with the absence of other positive bacteriological samples and/or digestive symptoms, suggest that this post-traumatic chronic osteitis occurred after a telluric contamination.…”

Surgical treatment of recurrent acute lymphoblastic leukemia with humeral osteomyelitis as the first symptom: a case report and literature review

“…Very few patients with acute lymphoblastic leukemia (ALL) experience complications with osteomyelitis during chemotherapy (1)(2)(3)(4)(5)(6). Recurrent ALL for which the first symptom is osteomyelitis involving the entire long bone is very rare.…”

Clostridium cadaveris Osteomyelitis: an Unusual Pathogen which Highlights the Importance of Deep Tissue Sampling in Chronic Osteomyelitis

“…There are approximately 30 cases of Clostridial osteomyelitis published to date (Table 1 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]). Of note, since 2016, Clostridioides difficile (previously Clostridium difficile) is considered a different genus based on phenotypic, chemotaxonomic and phylogenetic analysis [26] and so is not considered further here.…”

“…Osteomyelitis due to clostridial species usually follows trauma [14] or open fractures [7,8,11,12,[15][16][17][18], some obviously contaminated with soil [12,15,17] or sewerage [8,11]. In non-traumatic cases hosts may be immunocompromised by lymphoma [13,22] or diabetes [10], though sometimes there is neither a clearly identifiable source nor host risk factor [9]. Nine of these cases have been reported in the last five years which likely reflects laboratory advances in diagnostic capabilities including improved anaerobic culture techniques and the increasing availability of MALDI-TOF mass spectrometry and genetic sequencing for exact species determination.…”