Clostridium septicum causing aortic aneurysm, spondylodiscitis, and epidural abscess in an immunocompetent man

Clostridium septicum is an opportunistic pathogen residing in the human gut flora. Due to its aerotolerance and production of exotoxins, dissemination is an uncommon but potentially lethal condition, often associated with underlying malignancy. This report represents the first described case of a patient with aortic, musculoskeletal and epidural infection caused by C. septicum. It illustrates an example of successful treatment and discusses specific treatment options in relation to current antibiotic and surgical recommendations.

We report a rare case of a 76-year-old man presenting with mild symptoms, who developed life-threatening complications caused by C. septicum including an aortic aneurysm as well as an epidural abscess and spondylodiscitis. The patient was successfully treated with endovascular stents in conjunction with a six-week course of intravenous antibiotics and was discharged from the hospital with oral clindamycin. After more than a year on oral antibiotics the treatment was terminated, which promptly led to a relapse of C. septicum bacteremia and spondylodiscitis. Following a second hospitalization with IV therapy, lifelong suppressive antibiotic therapy was deemed necessary.

C. septicum bacteremia is a severe condition that may cause multifocal infection although presenting with few clinical signs. This unique case reflects the aggressiveness of the bacteria and how antibiotic and surgical treatment should be thoughtfully considered in the presence of aortitis, epidural abscesses and spondylodiscitis.