{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T09:51:04Z","timestamp":1791193864198,"version":"4.1.0"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Investigative Medicine High Impact Case Reports"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:p>\n                    Nontraumatic clostridial myonecrosis infections are predominantly caused by\n                    <jats:italic toggle=\"yes\">Clostridium septicum<\/jats:italic>\n                    . Most patients have an underlying gastrointestinal malignancy. This case presents a rare association of spontaneous clostridial myonecrosis preceding cerebral septic emboli with underlying invasive colorectal adenocarcinoma. A 60-year-old male with a history of hypertension, diabetes, and a family history of colon cancer presented to the emergency room with worsening left-sided chest pain radiating to his left shoulder. Extensive workup revealed elevated D-dimer, troponin, C-reactive protein, white blood cell count, and creatinine phosphokinase. Due to his clinical signs, symptoms, elevated white count, and further decompensation, he was started on antibiotics for sepsis. Physical exam revealed left upper extremity (LUE) crepitus consistent with imaging of innumerable soft tissue gas collections along the LUE. Incision, drainage, and myomectomy were performed due to concerns of myositis and necrotizing infection. Muscle biopsy revealed myonecrosis, and subsequent samples were positive for\n                    <jats:italic toggle=\"yes\">C. septicum<\/jats:italic>\n                    . Postoperative pressor support and several sessions of surgical debridement were required. He continued to deteriorate and developed left-sided paralysis. Computed tomography head revealed several white matter infarcts indicative of septic emboli. The patient slowly recovered neurologically after switching to central nervous system-penetrating antibiotics. Months later, a colonoscopy revealed cecal adenocarcinoma. This case features a unique course of spontaneous\n                    <jats:italic toggle=\"yes\">C. septicum<\/jats:italic>\n                    infection. There are high mortality rates, and previous studies report an association with colorectal malignancies. Therefore, preventative and diagnostic evaluations are imperative with a confirmed\n                    <jats:italic toggle=\"yes\">C. septicum<\/jats:italic>\n                    infection. To our knowledge, this is the first case reported of cerebral septic emboli secondary to spontaneous myonecrosis with\n                    <jats:italic toggle=\"yes\">C. septicum<\/jats:italic>\n                    , highlighting a unique burden of emboli-induced neurological deficits.\n                  <\/jats:p>","DOI":"10.1177\/23247096251342027","type":"journal-article","created":{"date-parts":[[2025,5,31]],"date-time":"2025-05-31T05:58:32Z","timestamp":1748671112000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cerebral Septic Emboli: A Unique Complication of\n                    <i>Clostridium septicum-<\/i>\n                    Induced Myonecrosis"],"prefix":"10.1177","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4777-8169","authenticated-orcid":false,"given":"Lily","family":"Xu","sequence":"first","affiliation":[{"name":"California Northstate University, College of Medicine, Elk Grove, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2551-3821","authenticated-orcid":false,"given":"Iyawnna","family":"Hazzard","sequence":"additional","affiliation":[{"name":"California Northstate University, College of Medicine, Elk Grove, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faith","family":"Sumandea","sequence":"additional","affiliation":[{"name":"California Northstate University, College of Medicine, Elk Grove, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yui","family":"Seo","sequence":"additional","affiliation":[{"name":"California Northstate University, College of Medicine, Elk Grove, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ardavan","family":"Afrasiabi","sequence":"additional","affiliation":[{"name":"Oroville Hospital, Oroville, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,31]]},"reference":[{"key":"e_1_3_2_2_2","first-page":"1216","article-title":"Myositis and myonecrosis","volume":"2015","author":"Pasternack MS","unstructured":"Pasternack MS, Swartz MN. Myositis and myonecrosis. In: Bennett JE, Dolin R, MJ Blaser MJ eds. Mandell, Douglas, and Bennett\u2019s Principles and Practice of Infectious Diseases; Philadelphia, PA: Elsevier Saunders; 2015:1216-1225.e2.","journal-title":"Mandell, Douglas, and Bennett\u2019s Principles and Practice of Infectious Diseases"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/12.2.286"},{"key":"e_1_3_2_4_2","first-page":"202","volume-title":"Laboratory Diagnosis of Infectious Diseases: Principles and Practice","author":"George WL","unstructured":"George WL, Finegold SM. Clostridial myconecrosis (Gas gangrene). In: Balows A, Hausler WJ, Ohashi M, Turano A, Lennete EH eds. Laboratory Diagnosis of Infectious Diseases: Principles and Practice. Springer; 1988:202-204."},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(79)90483-2"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-198103000-00020"},{"issue":"5","key":"e_1_3_2_7_2","first-page":"264","article-title":"Endogenous gas gangrene","volume":"98","author":"Klotz PG.","year":"1968","unstructured":"Klotz PG. Endogenous gas gangrene. 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