Aspiration Pneumonia Leading to Clostridium ramosum Bacteremia in a Neutropenic Patient: Case Report and Management Strategy

BACKGROUND Clostridium ramosum is an anaerobic, spore-producing, gram-positive rod, enteric pathogen that is difficult to identify and is rarely pathogenic. We present a case of Clostridium ramosum bacteremia secondary to aspiration pneumonia in a 65-year-old immunocompromised man on chemotherapy for follicular lymphoma. CASE REPORT We report the case of a 65-year-old man, on active chemotherapy for follicular lymphoma, presenting with a fever of 38.3°C, nonproductive cough, fatigue, and confusion. Physical examination was unremarkable except for +2 lower-extremity pitting edema. CT abdomen pelvis showed left lower-lung consolidation and CT chest angiogram showed that the consolidation was concerning for infarct verses abscess and segmental/subsegmental pulmonary emboli despite anticoagulation use. Blood cultures later grew Clostridium ramosum, which was successfully treated with IV piperacillin-tazobactam. Subsequent outpatient imaging demonstrated resolution of the lung consolidation. CONCLUSIONS Our case highlights the rare diagnosis of Clostridium ramosum bacteremia secondary to aspiration pneumonia in an immunocompromised patient and our approach to management. We highlight the difficulties in identification of Clostridium ramosum, rare pathogenicity, risk factors, and potential sources.