Recognition, management, and prevention of Clostridium septicum abscess in immunosuppressed patients
M. E. Kolbeinsson, W. D. Holder Jr and S. Aziz
Department of Surgery, Stanford University School of Medicine, Calif.
Spontaneous gas gangrene due to Clostridium septicum is a rapidly
progressing disease that usually ends in fatal toxemia. We report three
cases of asymptomatic C septicum abscesses to document the clinical course
of this entity and to establish guidelines for its prevention and
treatment. In contrast to previously reported data, C septicum infections
can produce abscesses in solid organs, the retroperitoneum, and the
extremities. These lesions often occur in patients with cancer, producing
liver abscesses without gas formation that may be misinterpreted as
metastatic carcinoma. Symptoms may be minimal or nonspecific before
fulminant toxemia. Asymptomatic bacteremia should prompt a search for
unsuspected cancer and an abscess. Computed tomography is the diagnostic
modality of choice. The treatment consists of surgical debridement of
necrotic tissue in concert with an appropriate course of antibiotics. We
have found recurrences after adequate debridement and short-term antibiotic
therapy, suggesting that prolonged and even lifelong prophylactic oral
penicillin G potassium may be necessary to prevent further recurrences.
