Critical Care: Student/Resident Case Report Poster - Critical Care III |

Clostridium Subterminale Sepsis in an Immunocompetent Patient Without Other Risk Factors: A Case Report FREE TO VIEW

Kevin Patel, MD; Kimberly Cao, MD
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University of South Florida, Tampa, FL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):421A. doi:10.1016/j.chest.2016.08.434
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SESSION TITLE: Student/Resident Case Report Poster - Critical Care III

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION:Clostridium subterminale is an anaerobic, spore-forming, gram-positive bacteria normally found in soil. It is a rare pathogen that has only been described in 10 prior cases, with only two presenting as septicemia in immunosuppressed patients. A prominent risk factor is deep tissue injury. Other cited presentations were empyema, soft tissue infection, and meningitis after craniocerebral arrow injury. We present a case of Clostridium subterminale in an immunocompetent patient without penetrating injury.

CASE PRESENTATION: 52 year old male with diabetes, chronic kidney disease, pulmonary emboli, and diastolic dysfunction was found down at home and brought in by EMS. On arrival, patient was intubated in severe shock with high anion gap metabolic acidosis (AG 26), hyperglycemia (1720), and acute renal failure (Cr 8.0). Physical exam was remarkable for mild abrasions on his knees and cool skin. Chest x-ray was unremarkable, pan cultures were ordered and patient started on vancomycin and zosyn. Despite four pressors, our patient decompensated with ventricular tachycardic arrest, but was revived. Bedside echo revealed EF 40-45%. Given worsening status and chest imaging with ARDS, antibiotics broadened. Dialysis was initiated for anuric kidney failure and worsening acidosis. On hospital day (HD) 3, patient developed DIC and shock liver. Large bullae appeared on bilateral lower extremities where previous abrasions were noted by HD4. Our patient continued to decompensate and patient’s family decided to focus on comfort measures only. Patient passed by HD 5 and two days later cultures revealed Clostridium subterminale.

DISCUSSION:C. subterminale is rarely virulent and does not typically present as an isolated pathogen. There are only 10 cases in the literature, of which most are after penetrating or deep tissue injuries and only 2 cases of bacteremia in immunosuppressed patients. However, our patient was immunocompetent without risk factors. A possible source of infection was the mild abrasions on his lower extremities.

CONCLUSIONS: This is the first case of C. subterminale septicemia that we know of, to present in an immunocompetent host without clear risk factors. Despite adequate antimicrobial therapy patient continued to decompensate. It is important that clinicians are aware of this pathogen and further delineation of risk factors are needed.

Reference #1: Thind, S et al. Clostridium subterminale septicemia in a patient with esophageal cancer. ID Cases (2014); 1 (3): 47-49.

Reference #2: Hauseen, D et al. Clostridium subterminale sepsis in adult acute lymphoblastic leukemia. Leukemia & Lymphoma 2001; 52 (6): pages 1137-1138

Reference #3: Ishaque, N et al. Clostridium Subterminale Presenting As Tension Hydropneumothorax. Rare and Illustrative ICU Infections and Exposures 2014. (D106) A6489-A6489

DISCLOSURE: The following authors have nothing to disclose: Kevin Patel, Kimberly Cao

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