Case Presentation:

A 71 year old female with recent diagnosis of adenocarcinoma of ascending colon presented to the hospital with complaints of pain and rapid development of swelling in right foot that started 3 hours prior to arrival. She noticed a small lesion on her right heel which expanded to a large blister about tennis ball in size within 3 hours without any trauma to her foot. Physical examination was significant for fever of 38.7C, heart rate of 125 per minute along with edema and extreme tenderness in the right foot. At the right heel, there was a large blister about 10 cm x 8 cm in size. Laboratory studies revealed elevated leukocyte count of 25,000 with left shift and blood culture grew clostridium septicum. MRI of right foot showed gas gangrene of the right heel for which she underwent incision and drainage of the blister along with local debridement of necrotic tissue. All this while she was on broad spectrum intravenous antibiotics which were later changed to organism targeted oral ampicillin and metronidazole.

Discussion:

Spontaneous clostridium septicum infections are rare and estimated to be the cause of only 1.3% of all clostridia infections. Being a rare infection, it is not well studied. However, It has been observed that almost half of the patients diagnosed with clostridium septicum infection have primary malignancy, most common being colon carcinoma (75%) of which 40% patients had cecal cancer. Current literature suggests that mucosal ulceration of the tumor surface and hematogenous invasion allow a portal of entry for the bacteria. It usually presents as spontaneous gas gangrene of either upper or lower extremity. Early initiation of antibiotics along with aggressive surgical debridement is the mainstay of treatment. Penicillin group of medications are the drug of choice for clostridium septicum infection, however duration of the antibiotics is not well studied. Generally 10-14 days of antibiotics have shown successful response.

Conclusions:

Clostridium septicum is a rare cause of spontaneous gas gangrene most commonly associated with colon cancer. Hematogenous invasion from the gut is the most common portal of entry. Early diagnosis and treatment is very essential as delay in the diagnosis can lead to adverse outcomes with mortality rate up to 70%.