Clostridium septicum aortitis and mediastinitis complicating perforated appendicitis in a patient with chronic myelomonocytic leukemia: A case report.
Jamil Muqtadir, Sameeullah Bhatti, Abdul Rasheed et al.
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Case in brief
A 71-year-old man with untreated chronic myelomonocytic leukemia presented with back pain, vomiting, and rigors. CT demonstrated perforated appendicitis, mediastinitis, and aortitis involving the aortic arch and diaphragmatic hiatus. Despite broad-spectrum antibiotics and nonoperative management of the appendicitis, the arch developed new aneurysmal dilatation to 5.1 cm by day 5. He underwent carotid-subclavian bypass and thoracic endovascular repair, followed by open debridement and muscle-flap coverage of necrotic aortic tissue. Cultures grew Clostridium septicum. After intravenous antibiotics and lifelong oral suppression for retained prosthetic material, he was discharged ventilator-dependent to long-term acute care.
What made this case unusual
The aortitis occurred with perforated appendicitis despite a colonoscopy twelve months earlier showing only polyps and diverticulosis, illustrating a non-colorectal-neoplasm context for C. septicum infection.
Diagnostic / clinical pearl
In a patient with hematologic disease and aortitis, consider C. septicum even when colorectal neoplasia is not evident; perforated appendicitis may be a potential infectious source.
Why it matters
The case highlights the difficulty of source control when appendicitis is managed nonoperatively in an immunocompromised patient with rapidly progressive aortic infection.