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Clostridium septicum myonecrosis complicating diarrhea-associated hemolytic uremic syndrome

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Abstract

We report the case of a 19-month-old male child with diarrhea-associated hemolytic uremic syndrome (HUS) who developed swelling of the right arm at the site of a peripherally inserted central venous catheter (PICC), fever, and later, ecchymosis. Wound cultures at the time of surgical debridement grew Clostridium septicum. The child subsequently required amputation of the right arm and prolonged therapy with parenteral penicillin and clindamycin. Clostridium septicum infections in children with HUS have been associated with a high rate of mortality. Along with colon cancer, diarrhea-associated HUS comprises a clinical entity which appears to predispose to atraumatic C. septicum infection, where acidic and anaerobic conditions in the diseased colon favor C. septicum invasion. Though not well recognized among pediatric nephrologists, C. septicum infection constitutes a severe, albeit rare, complication of diarrhea-associated HUS, but one in which a high index of suspicion is warranted as aggressive surgical and antibiotic therapy may be life-saving.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, 11133 Doctors’ Office Tower, 2200 Children’s Way, Nashville, TN, 37232-9560, USA

    Tracy E. Hunley & Kathy Jabs

  2. U.S. Military Malaria Vaccine Program, Walter Reed Army Institute of Research-Naval Medical Research Center, Silver Spring, MD, USA

    Michele D. Spring

  3. Section of Pediatric Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Timothy R. Peters

  4. Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA

    Douglas R. Weikert

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  1. Tracy E. Hunley
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  2. Michele D. Spring
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  3. Timothy R. Peters
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  4. Douglas R. Weikert
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  5. Kathy Jabs
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Correspondence to Tracy E. Hunley.

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Hunley, T.E., Spring, M.D., Peters, T.R. et al. Clostridium septicum myonecrosis complicating diarrhea-associated hemolytic uremic syndrome. Pediatr Nephrol 23, 1171–1175 (2008). https://doi.org/10.1007/s00467-008-0774-5

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  • DOI: https://doi.org/10.1007/s00467-008-0774-5

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