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Isolated meningeal vasculopathy associated with Clostridium septicum infection
R S Crowley1, A Lembke, D S Horoupian
1Division of Neuropathology, Stanford University Medical Center, CA 94305, USA.
Abstract:
A 28-year-old patient with acute lymphoblastic leukemia and neutropenia developed necrotizing enterocolitis and Clostridium septicum bacteremia, followed by rhabdomyolysis, skin rash, and acute neurologic changes. Numerous cortical leptomeningeal enhancements were present on head MRI. Meningeal and brain biopsy showed segmental, full-thickness lysis of smooth muscle cells of medium-sized meningeal vessels with overall preservation of the structure of the vessel wall.
Insights
Necrotizing enterocolitis and Clostridium septicum bacteremia complicated an acute lymphoblastic leukemia patient, leading to rhabdomyolysis and neurologic issues. Meningeal biopsy revealed smooth muscle cell lysis in cerebral vessels, suggesting a potential link between infection and vascular complications.
Area of Science:
- Neurology
- Infectious Diseases
- Oncology
Background:
- Acute lymphoblastic leukemia (ALL) is a hematologic malignancy.
- Neutropenia is a common complication of ALL and its treatment.
- Clostridium septicum is an anaerobic bacterium known to cause serious infections.
Observation:
- A patient with ALL and neutropenia developed severe complications including necrotizing enterocolitis and C. septicum bacteremia.
- The patient presented with rhabdomyolysis, skin rash, and acute neurologic changes.
- Cranial magnetic resonance imaging (MRI) revealed leptomeningeal enhancement.
Findings:
- Meningeal and brain biopsy demonstrated segmental lysis of smooth muscle cells in medium-sized meningeal vessels.
- The overall structure of the meningeal vessel walls was preserved despite smooth muscle cell lysis.
- This histological finding suggests a specific vascular pathology potentially related to the infectious process.
Implications:
- The findings suggest a potential mechanism by which C. septicum bacteremia may cause neurologic complications in immunocompromised patients.
- This case highlights the importance of considering infectious etiologies in patients with leukemia experiencing unusual neurologic and vascular events.
- Further research is warranted to elucidate the precise pathogenesis of smooth muscle cell lysis in meningeal vessels during C. septicum infections.