Uterine Clostridium perfringens infection related to gynecologic malignancy

Kevin M Kremer; Megan E McDonald; Michael J Goodheart

doi:10.1016/j.gore.2017.09.006

Back

Uterine Clostridium perfringens infection related to gynecologic malignancy

Journal article

Open access

Peer reviewed

Uterine Clostridium perfringens infection related to gynecologic malignancy

Kevin M Kremer, Megan E McDonald and Michael J Goodheart

Gynecologic Oncology Reports, Vol.22(C), pp.55-57

11/2017

DOI: 10.1016/j.gore.2017.09.006

PMCID: PMC5635240

PMID: 29034307

Files and links (1)

url

https://doi.org/10.1016/j.gore.2017.09.006View

Published (Version of record) Open Access

Abstract

Uterine gas gangrene caused by Clostridium perfringens is a serious, often life-threatening infection that is rarely encountered in the practice of gynecologic oncology. However, the hypoxic nature of gynecologic cancers due to necrosis and/or prior radiation therapy creates a microenvironment optimal for proliferation of anaerobic bacteria such as the Clostridium species. Early recognition and aggressive treatment with IV antibiotics and surgical debridement remain the cornerstones of management in order to decrease morbidity and mortality. Here we present the case of a 52year-old woman with a remote history of cervical cancer who was previously treated at our institution with primary chemotherapy and radiation and was then admitted decades later with Clostridium perfringens bacteremia and CT evidence of intrauterine abscess. The patient received a prolonged course of IV antibiotic therapy and subsequently underwent definitive surgical management with a total abdominal hysterectomy, bilateral salpingo-oophorectomy, small bowel resection with anastomosis for a utero-ileal fistula identified intraoperatively. Pathology from the uterine specimen demonstrated a primary poorly differentiated uterine adenocarcinoma. The patient recovered fully from her Clostridium perfringens infection and was discharged from the hospital shortly after surgical intervention. •The hypoxic nature of tumors creates a milieu optimal for growth of anaerobic bacteria.•Risk of 2° uterine malignancy is elevated following radiation for cervical cancer.•Uterine gas gangrene caused by C. perfringens is often a life-threatening infection.•Morbidity and mortality are directly linked to delayed recognition.•Cornerstones of treatment are IV antibiotics and surgical debridement.

Gynecologic malignancy

Endometrial cancer

Clostridium perfringens

Pelvic radiation

Details

Title: Subtitle: Uterine Clostridium perfringens infection related to gynecologic malignancy
Creators: Kevin M Kremer - Department of Obstetrics and Gynecology, University of Missouri, Columbia, MO 65202, United States
Megan E McDonald - Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, United States
Michael J Goodheart - Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, United States
Resource Type: Journal article
Publication Details: Gynecologic Oncology Reports, Vol.22(C), pp.55-57
DOI: 10.1016/j.gore.2017.09.006
PMID: 29034307
PMCID: PMC5635240
NLM abbreviation: Gynecol Oncol Rep
ISSN: 2352-5789
eISSN: 2352-5789
Publisher: Elsevier Inc
Language: English
Date published: 11/2017
Academic Unit: Obstetrics and Gynecology
Record Identifier: 9983931822102771

Metrics

43 Record Views

10 Times Cited - Web of Science