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Received Nov 5, 2017; Accepted Apr 26, 2018
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
The Clostridium genus is comprised of mostly Gram-positive, variably spore-forming anaerobic to aerotolerant rods in pairs or short chains. They most commonly colonize the human GI and female genitourinary tracts, but more rarely, the skin’s surface or the oral cavity. They are widely found in the environment, as they are components of the digestive flora in mammals [1]. Given the ubiquity of Clostridia, their reservoirs include humans, animals, and the environment. Only a few of the nearly 200 Clostridia species are pathogenic to humans, but while they are some of the most extensively studied pathogenic anaerobes, there is limited literature regarding Clostridium subterminale [1]. Further, while there are many generalizations regarding Clostridia–frequently opportunistic pathogens that produce spores and protein exotoxins–members of the genus exhibit such heterogeneity that there are many exceptions or only specific conditions under which generalizations will apply [1]. Therefore, novel cases, especially of the lesser-studied organisms, are of particular importance among Clostridium literature.
2. Case Report
A 72-year-old male with a past medical history of quadriplegia, hypertension, hyperlipidemia, neurogenic bladder, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and chronic hepatitis presented to the emergency department with an acute change in mental status. He was a full-time resident at an assisted living nursing home, and his baseline mental status was awake, alert, and oriented to person, place, and time (AAOx3). Upon arrival in the emergency department, he was oriented only to self. Prior to this admission, the patient was being treated for a urinary tract infection and was on day seven of nitrofurantoin and cefepime. On examination, he was hypotensive at a blood pressure of 81/59 mmHg, pulse rate of 115 beats per minute, respiratory rate of 21 breaths per minute, and oxygen saturation of 78% while breathing ambient air. He was in visible respiratory distress and was lethargic, but arousable. He received a nebulizer treatment and was placed on a non-rebreather mask at 6 liters, after which his oxygen saturation rose to 99%. A chest X-ray was taken and revealed...