The Clostridium species is a gram positive, anaerobic, rod-shaped microbe that is known to produce many toxins. Most infections by the Clostridium species involve C. botulinum, C. difficile, and C. perfringens. However, other types of Clostridium species are also clinically relevant, such as C. septicum and C. tertium. We discuss a case of a 79-year-old patient with a past medical history of prostate cancer and alcohol abuse who presented to the hospital after being found down. They were admitted to the ICU for septic shock, and initial blood cultures grew C. septicum, C. tertium, and E. coli. A CT of the abdomen and pelvis with IV contrast showed pneumoperitoneum and a loculated pericolic fluid collection concerning for colon perforation. Initially the patient had a benign abdominal exam, but later developed significant distention and tenderness that required an emergent exploratory laparotomy and total abdominal colectomy. The patient was found to have three separate colon perforations, and no malignancy on histopathology. C. septicum is a highly virulent pathogen, and there are several cases reporting C. septicum-associated endocarditis, aortitis, and endophthalmitis. It is also associated with colon and hematologic malignancies and neutropenia. Common risk factors for C. tertium include immunocompromised status, neutropenia, hematologic malignancy, exposure to beta-lactam antibiotics, cirrhosis, and intestinal mucosal damage. It seems to have low virulence and low mortality when treated correctly. It is important that any patient found to have Clostridium bacteremia be evaluated for a gastrointestinal source and treated promptly and appropriately.

Background: Multiple studies have investigated the correlations of mortality, mechanical ventilation, and intensive care unit (ICU) admissions with CAC scores. This analysis overviews the prognostic capability of CAC scoring in mortality, mechanical ventilation, and ICU admission for hospitalized COVID-19 patients. Methods: Online search was conducted on PubMed, Cochrane Library, and Scopus from inception to 22 November 2021 to identify studies involving CAC scores in relation to ICU admission, mechanical ventilation, and death rates. Results: A total of eight studies were analyzed. In the absence of CAC group compared with the presence of CAC score, there was an increase in mortality in the presence of CAC (RR 2.24, 95% CI, 1.41–3.56; p < 0.001). In the low CAC group and high CAC group, high CAC group had increase in mortality (RR 2.74; 95% CI, 1.94–3.86; p < 0.00001). There was no statistical difference in outcomes of mechanical ventilation and ICU admission between any of the groups. Conclusion: This meta-analysis strictly examined the outcomes of interest in death, mechanical ventilation, and ICU admission while comparing the CAC scores in patients with COVID-19. Given these findings, CAC scoring can aid in stratifying patients, thus allowing earlier interventions in rapidly developing illnesses.

Background. Coronavirus 2019 (COVID-19) was initially identified approximately in December 2019 at Wuhan, China, as patients presented with vague prodromal and respiratory symptoms. With the developing investigation of its clinical manifestation, cardiac symptoms have been widely reported including acute coronary syndromes, myocarditis, arrhythmias, heart failure, and cardiac arrest. Case Summary. An 84 year-old male with history of coronary artery disease, hypertension, and hyperlipidemia presented to an outside urgent care with prodromal symptoms. The patient had received the second Pfizer vaccine three months prior. This presentation, he was found to be COVID-19 positive as well as bradycardic with a complete AV block. He was transferred to a tertiary center for further evaluation and management. However, after transfer, the patient refused further invasive cardiac interventions and after medical therapy was discharged home in complete AV block. Discussion. We report a novel case of a Pfizer-vaccinated patient whose initial presenting symptoms of COVID-19 included a complete AV block as well as the challenges and difficulties in approaching such patients. Although this patient's etiology of his complete AV block may result from multiple factors, given the acuity in setting of concurrent COVID-19 infections, top differentials include viral myocarditis, COVID-19-induced Takotsubo cardiomyopathy complicated by a complete AV-block, or a direct conduction pathway infection. Management of patients should focus on a multidisciplinary approach, and prevention is critical via vaccination.

The following report illustrates a case of a 36-year-old Caucasian male with intravenous drug use (IVDU) induced septic thrombophlebitis presenting with recurrent unilateral pneumothoraces from septic pulmonary embolism (SPE) without the presence of obvious right-sided valvular vegetation in infective endocarditis (IE), defined as tricuspid or pulmonary valve lesions. Pneumothorax (PTX) has been observed as a rare complication of SPE and is commonly associated with infective right-sided IE, IVDU, and intravascular indwelling catheters. However, this case is novel as it is the very rare documented case of recurrent, unilateral, spontaneous right PTX refractory to multiple chest tube placements in such a setting. Therefore, the absence of detectable right-sided valvular vegetation in IE does not obviate the risk of SPE-induced PTX in IVDU and further expands the realm of infectious and pulmonary consequences of SPE and IVDU.