A fatal complication of colon cancer.

A 90-year-old female was admitted with a probable adverse reaction to codeine phosphate after a 10-day history of lethargy, abdominal pain and increased colostomy output. A recent staging CT thorax/abdomen/pelvis showed a recurrence of a previous colon cancer with lung metastasis. She was pyrexial, but initial clinical examination was unremarkable. Sixteen hours later, she deteriorated and developed subcutaneous emphysema of her left chest wall with signs of disseminated intravascular coagulation (Figure 1). A presumptive diagnosis of septic shock was made and intravenous antibiotics were administered, but the patient passed away several hours later. Penicillin-sensitive Clostridium septicum was grown from an anaerobic blood culture bottle within 24 h of admission. Infections with C. septicum have an overwhelming association with colorectal cancer and often not suspected in the early stages [1]. This case highlights the importance of prompt resuscitative treatment and antibiotics in patients with C. septicum infection as mortality approaches 100% if left untreated for 24 h [2].