A Life- and Limb-Threatening Case of Clostridium septicum in a Total Hip Arthroplasty

Abstract

A 46-year-old male with bilateral metal-on-metal hip prostheses presented with a left periprosthetic hip infection, as well as chronic, progressive osteolysis of the proximal femur and acetabulum with pelvic erosion. Three years before, the bearing surface was changed to metal-on-polyethylene prosthesis during an attempted revision but was complicated by extensive blood loss. At our institution, gross inspection demonstrated a soft-tissue hip mass of unknown etiology. Open biopsy and culture were performed, but extensive hemorrhaging required interventional radiology. Cultures revealed Clostridium septicum infection—known for its associations with gastrointestinal malignancy. Workup in the hospital was negative for malignancy, and definitive management was left hip disarticulation and intravenous antibiotics. The patient developed a chronic wound on the left hip incision but was ultimately lost to follow-up.

Keywords

• Clostridium septicum
• Total hip arthroplasty
• Periprosthetic infection
• Malignancy