Background:
The Clostridium species is a gram positive, anaerobic, rod-shaped microbe that is known to produce many toxins. Most infections by the Clostridium species involve C. botulinum, C. difficile, and C. perfringens. However, other types of Clostridium species are also clinically relevant, such as C. septicum and C. tertium.
Case summary:
We discuss a case of a 79-year-old patient with a past medical history of prostate cancer and alcohol abuse who presented to the hospital after being found down. They were admitted to the ICU for septic shock, and initial blood cultures grew C. septicum, C. tertium, and E. coli. A CT of the abdomen and pelvis with IV contrast showed pneumoperitoneum and a loculated pericolic fluid collection concerning for colon perforation. Initially the patient had a benign abdominal exam, but later developed significant distention and tenderness that required an emergent exploratory laparotomy and total abdominal colectomy. The patient was found to have three separate colon perforations, and no malignancy on histopathology.
Discussion:

C. septicum is a highly virulent pathogen, and there are several cases reporting C. septicum-associated endocarditis, aortitis, and endophthalmitis. It is also associated with colon and hematologic malignancies and neutropenia. Common risk factors for C. tertium include immunocompromised status, neutropenia, hematologic malignancy, exposure to beta-lactam antibiotics, cirrhosis, and intestinal mucosal damage. It seems to have low virulence and low mortality when treated correctly. It is important that any patient found to have Clostridium bacteremia be evaluated for a gastrointestinal source and treated promptly and appropriately.