Background: This report highlights the first published case of fatal septic shock associated with Clostridium perfringens and Enterococcus avium bacteremia due to infective gastroenteritis. Case presentation:We report a case of hepatic infarction, abscess, and death following gastroenteritis in a 63year-old Aboriginal man who initially presented to a rural hospital with suspected food poisoning. The patient had persistent fever and was commenced on empirical antibiotics. His blood culture results were positive for Clostridium perfringens and Enterococcus avium. He was transferred to a tertiary center but developed organ failure and refractory shock. Initial computed tomography of the abdomen was unremarkable, but repeat imaging showed small bowel enteritis, hepatic abscess, and infarction as a result of portal vein septic thromboembolism. Despite maximal intensive care treatment, including percutaneous drainage of hepatic abscess and broad antibiotic cover, the patient died 6 days after initial presentation. Conclusions: This case highlights the rare but commonly fatal course of sepsis associated with Clostridium perfringens bacteremia and demonstrates detrimental effects of coinfection with Enterococcus avium, including potential for rapidly seeding abscess formation. Lessons for rural practice are highlighted, including the need for urgent and early referral for intensive care support, particularly for patients with complex comorbidities.

Mycotic (infected) aneurysm involving the thoracic aorta is an exceedingly rare and life-threatening condition that is associated with high morbidity and mortality. We report an unusual source of Proteus mirabilis bacteraemia thought to be due to an infected aneurysm in the thoracic aortic arch in an elderly woman. Source of gram-negative bacteraemia is usually isolated to an intra-abdominal or a pelvic source. Proteus bacteraemia from an intrathoracic pathology is very uncommon, and in this case led to a delay in diagnosis. Although an infected aneurysm is a rare source of gram-negative bacteraemia, it must always be considered when common causes of bacteraemia have been ruled out especially in patients with vascular risk factors.