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Pneumocephalus and pneumorrhachis caused by Clostridium perfringens infection

  • Kazuki Maegawa
    Affiliations
    Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan
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  • Hiroaki Nishioka
    Correspondence
    Correspondence: Hiroaki Nishioka, MD, PhD, Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe City, Hyogo 650-0047, Japan
    Affiliations
    Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan
    Search for articles by this author
Open AccessPublished:December 06, 2021DOI:https://doi.org/10.1016/j.ijid.2021.12.311

      Keywords

      A 68-year-old man presented with a one-month history of fever. He was bedridden due to Parkinson's disease, and a central venous catheter was inserted in his left femoral vein for parenteral nutrition at another hospital two months previously. Computed tomography revealed air in the subarachnoid space (Fig. 1A,B), in the vertebral canal (Fig. 1C), and in the left femoral vein (Fig. 1D). Three sets of blood cultures grew Clostridium perfringens. The catheter was removed and ampicillin was intravenously administered. Cerebrospinal fluid (CSF) obtained on day 4 showed leukocytosis (440/μL, polymorphonuclear; 89%) and a protein level of 311 mg/dL. Although the CSF culture did not grow bacteria, probably due to prior antibiotic administration, we believe that the pneumocephalus and pneumorrhachis were caused by C. perfringens meningitis. He recovered with ampicillin treatment.
      Figure 1:
      Figure 1Computed tomography shows air in the subarachnoid space of the frontal lobes (A) (arrows) and sella turcica (B) (arrows), in the vertebral canal (C), and in the left femoral vein along the catheter (D) (arrows).
      Central nervous system infections by C. perfringens are rare (
      • Finsterer J
      • Hess B.
      Neuromuscular and central nervous system manifestations of Clostridium perfringens infections.
      ), and only a few cases presenting pneumocephalus have been reported (
      • Klein MA
      • Kelly JK
      • Jacobs IG.
      Diffuse pneumocephalus from Clostridium perfringens meningitis: CT findings.
      ;
      • Goyal M
      • Sharma R
      • Berry M.
      Diffuse pneumocephalus due to meningitis: CT findings.
      ). Most cases of C. perfringens meningitis have a recent history of trauma or neurosurgery, which serve as a point of entry (
      • Finsterer J
      • Hess B.
      Neuromuscular and central nervous system manifestations of Clostridium perfringens infections.
      ). In our case, the insertion of a femoral vein catheter may have served as an entry site.

      Funding

      This work did not receive any specific grant from agencies in the public, commercial or not-for-profit sectors.

      Conflict of interest

      The authors declare that they have no conflict of interest.

      Ethics approval

      Informed consent was obtained from the patient's family.

      Author contribution

      KM collected the data and wrote the first draft of the manuscript. HN coordinated the project and edited the manuscript. Both authors have read and approved the final manuscript.

      References

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