Clostridium septicum growth from a total knee arthroplasty associated with intestinal malignancy: a case report
1 Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, 4190 City Avenue, Philadelphia 19131, Pa, USA
2 Department of Medicine, Lankenau Medical Center, 100 Lancaster Avenue, Wynnewood, 19096, Pa, USA
3 Department of Orthopaedic Surgery, Lankenau Medical Center, 100 Lancaster Avenue, Suite 456, Wynnewood, 19096, Pa, USA
BMC Infectious Diseases 2012, 12:235 doi:10.1186/1471-2334-12-235Published: 2 October 2012
Previous reports of infection with Clostridium septicum have identified an unexpected association with concurrent malignancy. The reported rate of associated malignancy has been found to be as high as 81 percent. The purpose of this case report was to present a case of a total knee arthroplasty infected with C. septicum and the subsequent finding of an occult colonic malignancy.
A 74 year-old man underwent uneventful bilateral total knee arthroplasties. Two weeks post-operatively, he presented with acute swelling, redness and pain of the left knee. Aspiration of the knee was sent for cell count and culture. The cell count demonstrated 39,000 white blood cells per cubic millimeter with 71% of white blood cells identified as neutrophils. Synovial fluid cultures identified the presence of C. septicum, Enterobacter and coagulase negative Staphylococcus. After urgent irrigation and debridement and polyethylene exchange of the affected knee, the patient was placed on intravenous Penicillin G for a period of six weeks. Two weeks into his course of antibiotics, the patient developed hematochezia and was found to have an obstructive colonic malignancy. The patient underwent hemi-colectomy and has since made a complete recovery of both his malignancy and total knee arthroplasty infection.
Recognition of the association between C. septicum and malignancy is especially important considering the large predicted increase in total joint arthroplasty procedures over the coming decades. In addition to the standard treatment for infection after total joint arthroplasty, identification of Clostridium septicum should initiate a search for associated occult malignancy.