Subsequent cultures of blood and tissue fluid identified Clostridium septicum. Later, colonoscopy revealed a cecal mass. A right hemicolectomy showed a T2N1 invasive moderately differentiated colon adenocarcinoma. Patient had a long hospital course, complicated by osteomyelitis of right hip but with treatment and rehabilitation did recover. Spontaneous clostridial myonecrosis is a rare fulminant and frequently fatal infection, which may present in an insidious manner.
Immediate surgery is necessary for pain control and for recovery.
It is essential to seek an underlying cause for infection caused by this unusual organism, and not simply treat the presenting symptoms and signs. The association of Clostridial organisms with occult gastro-intestinal malignancy has been well established. The portal of entry of this bacterium is thought to be through the lesion in the intestine. This case illustrates the importance of early and complete diagnosis, aggressive treatment and awareness of the association of C. septicum with both diabetes mellitus and occult gastro- intestinal malignancy. In a time of declining support for graduate medical education, the residency program is particularly appreciative of the many gifts it receives to assure its continued financial health and long-term development.