Neutropenic enterocolitis due to Clostridium septicum infection

Three cases of neutropenic enterocolitis are described. This unusual condition occurs almost exclusively in neutropenic patients and has a fulminating course which is almost invariably fatal without surgical intervention. The lesion is centered on the caecum and hitherto its pathogenesis has been unclear, partly because most studies have been performed on material obtained at necropsy. In these three patients, all of whom were treated surgically, Clostridium septicum was identified by specific immunofluorescence in the bowel wall of the resected specimens. Two patients also had C septicum septicaemia. Various forms of mucosal damage can be identified which predispose towards invasion of the bowel wall by this organism. These cases provide further confirmation of a primary role for C septicum in the pathogenesis of neutropenic enterocolitis.