P5036 - Alcohol Induced Enteritis: A Rare Cause of Clostridium tertium Bacteremia

Juan G. Feliciano Figueroa, MD, Diego Roman Colon, MD, Orlando Rodriguez-Amador, MD, Jose Martin-Ortiz, MD, FACG
VA Caribbean Healthcare System, San Juan, Puerto Rico

Introduction: Clostridium tertium is a gram-positive, low virulent, nontoxin-producing aerotolerant bacillus that can be commonly found in the human gastrointestinal tract (GIT). Bacteria due to this pathogen is commonly found in neutropenic or immunocompromised patients but also has been found to cause bacteremia in patient with gastrointestinal malignancies. Non-neutropenic infections have been reported in patient with CLD or hallow organ perforation. Here we present a case of septic shock due to C. tertium bloodstream infection in a non-cirrhotic patient with alcohol induced enteritis (AIE).

Case Description/Methods: 64 y/o male who come to our institution to undergo an imaging study and while taking his vitals he was found hypotensive, reason for which he was sent to the ER. Physical exam was remarkable for cachexia and a benign abdomen. At evaluation, he reported around 6 episodes of watery diarrhea daily that started around 8 months ago. Diarrhea was associated with weight loss of 8kg in this time period and abdominal discomfort. Toxic habits were remarkable for alcohol abuse. He stated that diarrhea usually subsided with alcohol abstinence. Laboratories were remarkable for elevated AST and ALT with 2:1 ratio, hypoalbuminemia of 2.4g/dL and hypokalemia. CBC was normal. Infectious and metabolic diarrhea work up came negative except for the presence of C. difficile without the presence of its toxin. Abd/pelvic CT showed areas of inflammation and fat stranding of both small and large bowel. The patient was subsequently admitted to ICU with septic shock. Endoscopic studies with biopsies were performed to visualize and characterize the imaging findings but all came unremarkable. Blood cultures taken at admission came remarkable for C tertium. After antibiotic therapy and alcohol abstinence both sepsis and diarrhea resolved. The patient was discharged with alcohol cessation counseling.

Discussion: Here we portray a rare case of blood stream infection caused by C. tertium in a non-neutropenic patient. We understand that AIE mucosal injury and dysbiosis were the causes of diarrhea and poor nutritional status that predisposed the patient to develop this rare infection. To our knowledge, this is the first reported case of AIE as the cause of C. tertium infection. This unique case supports the idea that the presence of this pathogen in the blood is highly suggestive of an ongoing GIT pathology and should trigger an evaluation to identify the culprit of the translocation of low virulent bacterias.


Disclosures:


Juan G. Feliciano Figueroa, MD, Diego Roman Colon, MD, Orlando Rodriguez-Amador, MD, Jose Martin-Ortiz, MD, FACG. P5036 - Alcohol Induced Enteritis: A Rare Cause of <i>Clostridium tertium</i> Bacteremia, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.