Date Published: January 23, 2018
Publisher: John Wiley and Sons Inc.
Author(s): Yukio Sato, Dai Kujirai, Katsura Emoto, Toshiaki Yagami, Taketo Yamada, Manabu Izumi, Masaki Ano, Kenichi Kase, Kenji Kobayashi.
Necrotizing enterocolitis (NEC) caused by Clostridium butyricum is common in neonates; however, a case of NEC in adults has not been previously reported. An 84‐year‐old Japanese man developed C. butyricum‐related NEC during hospitalization for treatment of stab wounds to the left side of the neck and lower abdomen, without organ damage, and concomitant pneumonia.
The patient developed acute onset of emesis accompanied by shock during his admission; partial resection of the small intestine was carried out due to necrosis. Pathologic findings showed mucosal necrosis and extensive vacuolation with gram‐positive rods in the necrotic small intestine. Blood culture tests revealed C. butyricum infection. The patient’s condition improved after the surgery. He was moved to a rehabilitation hospital on day 66.
This study suggests that hospitalized adult patients who receive antibiotic treatment are at risk for NEC.
Several strains of Clostridium butyricum have been cultured from the stool of healthy children and adults.1 One of those strains, MIYAIRI 588, is used widely as a probiotic in Asia, including Japan.2 It has been reported that it inhibited the cytotoxicity of Clostridium difficile in an in vitro study and reduced C. difficile toxin A in an in vivo study.3, 4 However, some of these strains produce endotoxins and cause necrotizing enterocolitis (NEC) in neonates.5 The only toxin C. butyricum has been reported to produce is analogous to the type E botulinum neurotoxin secreted by Clostridium botulinum.6 After the first report of NEC due to C. butyricum type E in an infant,7 many similar cases have been reported, including two cases of intestinal botulism involving adolescents,8 and one case of sepsis in an adult.9 Additionally, cases of food‐borne botulism caused by C. butyricum have been reported.10 However, a case of NEC due to C. butyricum in an adult has not been reported to date.
An 84‐year‐old man visited our hospital owing to a neck (left) and abdominal penetrating injury by a short sword in a suicide attempt. The patient had a medical history of cerebral infarction and paroxysmal atrial fibrillation on apixaban. He lived in his home with his family and had no recent history of hospitalization or admission to a nursing home.
Necrotizing enterocolitis caused by C. butyricum is common in preterm neonates, and can be life‐threatening.5 However, to the best of our knowledge, no such cases have been reported in adults.
We present a rare case of successful management of a hospitalized elderly patient with NEC associated with C. butyricum. The present case suggests that hospitalized adults who receive antibiotic therapy carry a risk of critical illness associated with pathogenic C. butyricum.
Approval of the research protocol: N/A.