Clostridium paraputrificum-induced necrotizing enteritis and bacteremia: a rare case report and review of the literature

Introduction: Colon carcinoma is a prevalent gastrointestinal malignancy, representing a significant public health burden, necessitating integrated surgical and oncological interventions. In recent decades, the combination of surgical resection and systemic chemotherapy has become the mainstay of treatment, supported by evolving clinical protocols. Globally, post-operative adjuvant chemotherapy is generally considered safe; however, potential treatment-related complications include life-threatening bacteremia and myelosuppression. The occurrence of necrotizing enteritis (NE) following chemotherapy is exceedingly rare, and to date, NE induced by Clostridium paraputrificum has not been thoroughly summarized in the literature, particularly regarding its clinical manifestations, laboratory indicators, and management strategies. We describe a rare case of C. paraputrificum -induced NE and bacteremia in a colon cancer patient to provide a reference for clinical practice in managing this condition. Case Presentation: A 69-year-old male presented following chemotherapy with fever, nausea, vomiting, and abdominal pain and discomfort. Computed tomography (CT) revealed post-rectal surgery changes and dilated colonic loops with air-fluid levels. Subsequently, an X-ray confirmed significant colonic gaseous distension. Laboratory evaluation showed a profound systemic inflammatory response, with interleukin (IL)-6 and IL-8 levels reaching 4088.30 ng/L and 2139.90 ng/L, respectively. Following urgent surgical resection of the necrotic bowel, both tissue and blood cultures yielded C. paraputrificum . The patient achieved a favorable outcome through combined surgical intervention and targeted antimicrobial therapy. Conclusion: NE is a rare but catastrophic complication following chemotherapy for colon carcinoma. Patients usually present with abdominal pain best evaluated radiologically by CT scans; monitoring IL levels may offer high sensitivity for the early detection of severe inflammatory responses associated with C. paraputrificum . Prompt surgical resection and parenteral antibiotics remain the cornerstones of management for immunocompromised patients.