A 71-year-old man is brought to the emergency department because of a 2-day history of excruciating left thigh pain, weakness, and nausea. His medical problems include type 2 diabetes mellitus, hypertension, and benign prostatic hyperplasia. He is a lifetime non-smoker.
His blood pressure is 85/40 mm Hg and pulse is 114/min and regular. Mucous membranes are dry. Examination reveals magenta-bronze discoloration, crepitus, tenderness, and significant swelling over the left thigh.
Laboratory results are as follows:

A Foley catheter was placed and 200 mL of concentrated urine was drained. Intravenous antibiotics, analgesics, and bolus fluids were administered. CT scan of the thigh showed gas gangrene. He was emergently taken to the operating room for debridement. Four days later, the patient feels better. The Foley catheter is removed and he urinates without difficulty. Two sets of blood cultures sent on admission grow Clostridium septicum.
Which of the following additional studies would be indicated in this patient?

Question

A 71-year-old man is brought to the emergency department because of a 2-day history of excruciating left thigh pain, weakness, and nausea.  His medical problems include type 2 diabetes mellitus, hypertension, and benign prostatic hyperplasia.  He is a lifetime non-smoker.
His blood pressure is 85/40 mm Hg and pulse is 114/min and regular.  Mucous membranes are dry.  Examination reveals magenta-bronze discoloration, crepitus, tenderness, and significant swelling over the left thigh.
Laboratory results are as follows:

A Foley catheter was placed and 200 mL of concentrated urine was drained.  Intravenous antibiotics, analgesics, and bolus fluids were administered.  CT scan of the thigh showed gas gangrene.  He was emergently taken to the operating room for debridement.  Four days later, the patient feels better.  The Foley catheter is removed and he urinates without difficulty.  Two sets of blood cultures sent on admission grow Clostridium septicum.
Which of the following additional studies would be indicated in this patient?

Quizplus · Accepted Answer

11ec193a_962d_bc71_853d_b5572896bb97_MD0002_00 Clostridium septicum is commonly associated with spontaneous gas gangrene. Unlike other Clostridium species (e.g., Clostridium perfringens), a history of trauma is not required for infection. Infection usually spreads hematogenously from GI tract pathology. Most patients have underlying colonic malignancy, but other conditions such as inflammatory bowel disease and diverticulitis have also been associated with C. septicum infection. Thus, all patients with C. septicum bacteremia should be evaluated with colonoscopy. (Choice B to E) Clostridium septicum is not usually associated with lung, bladder, prostate, or cardiac pathology. Educational objective: Clostridium septicum usually presents with bacteremia followed by spontaneous gas gangrene in an extremity without a history of trauma. Since the bacteria originates in the GI tract and is associated with GI pathology (e.g., colon cancer), all patients with C. septicum bacteremia should undergo a colonoscopy. __________ References: Clostridium septicum aortitis with associated sigmoid colon adenocarcinoma (http://www.ncbi.nlm.nih.gov/pubmed/22304871) Clostridium septicum Sepsis and Colon Carcinoma: Report of 4 Cases. (http://www.ncbi.nlm.nih.gov/pubmed/21747861)

A 71-Year-Old Man Is Brought to the Emergency Department Because