Hindawi Publishing Corporation Case Reports in Medicine Volume 2011, Article ID 248453, 3 pages doi:10.1155/2011/248453 Case Report Clostridium septicum Sepsis and Colon Carcinoma: Report of 4 Cases Eric Mao,1 Aine Clements,2 and Edward Feller1 1 The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA 2 Division of Gynecologic Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA Correspondence should be addressed to Edward Feller, edward feller@brown.edu Received 1 February 2011; Accepted 13 April 2011 Academic Editor: Gerald S. Supinski Copyright © 2011 Eric Mao et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. An association exists between colon carcinoma and Clostridium septicum infection, especially bacteremia. We reviewed retrospectively all positive blood cultures for this organism at a 300-bed general hospital over 4 years. Four of 15 cases were associated with concurrent colon carcinoma. C. septicum infection was the presenting feature of previously undiagnosed large bowel malignancy in three patients. We report this small case series to alert clinicians to the diverse spectrum and diagnostic diﬃculties of this rare, potentially catastrophic association. Although commonly associated with necrotizing skin or soft tissue infections, this bacterium can present with nonspeciﬁc or atypical symptoms. All patients with positive blood cultures for C. septicum, even without clinical suspicion of large bowel malignancy, should undergo colonoscopy to evaluate for colon carcinoma. 1. Introduction There is a connection between certain bacterial infections and malignancy. The best-known relationship is between Streptococcus bovis infection and colon carcinoma, but there is another link between Clostridium septicum and large bowel malignancies [1–6]. Additionally, C. septicum has been associated with hematological malignancies, immunosup- pression, neutropenia, and diabetes mellitus [2, 3]. We report 4 cases of C. septicum septicemia associated with large bowel malignancy to alert clinicians to the diverse, potentially misleading features of this life-threatening association. 2. Case Presentation A retrospective review of blood culture results for C. septicum was performed over a 4-year period in a 300-bed general medical surgical hospital in Providence, RI. All patients with bacteremia caused by this organism were identiﬁed. Hospital charts were then assessed for any association with large bowel malignancy. Of 15 patients with positive blood cultures for C. septicum, 4 had biopsy-documented colon carcinoma. The age range was from 73 to 81, including 3 men and 1 woman. Each patient had fever of 1–7 days duration. One patient had a history of colon cancer resected surgically in the prior year. Evaluation of this patient documented unsuspected local recurrence of cancer in the colon. In the remaining 3 cases, symptoms due to clostridial infection were the presenting features of previously undiagnosed cancer. Only 2 of 4 had symptoms or signs suggesting abdominal pathology. The tumor was located in the cecum in each case. One patient had bacterial aortitis. No patient had gas gangrene, a necrotizing skin, or soft tissue infection (Table 1). No patient had another underlying disorder reported to be associated with C septicum infection. 3. Discussion Unlike S. bovis, C. septicum is not part of the normal bowel ﬂora and is a rare cause of infection, accounting for as few as 1.3% of all blood cultures positive for clostridium [7]. Our results support previous evidence that C. septicum infections are associated with gastrointestinal malignancy. In a review of 320 cases dating back to 1969, 39% had a gastrointestinal malignancy [7]. Another review of 32 cases found that one-half of patients had concurrent colorectal cancer [8]. Another review of 163 cases found that 34% had an associated colon carcinoma [9]. The mortality rate of C. septicum sepsis is prohibitive, reported to range from 45%