Temsirolimus therapy and small bowel perforation in a pediatric patient with Clostridium septicum bacteremia

• Temsirolimus may be implicated in non-neutropenic gastrointestinal perforation.
• Clostridium septicum infection should be considered in immunocompromised patients, particularly those with malignancy, who present with abdominal sepsis. Though rare, it is accompanied by very high rates of morbidity and mortality.
• Intestinal perforation and other complications of chemotherapy may occur in non-neutropenic patients and early surgical intervention may be warranted.

Temsirolimus has been demonstrated to result in significant disease stabilization in children with high-grade glioma, neuroblastoma, and rhabdomyosarcoma. While mucositis has been reported as a common adverse effect of temsirolimus therapy in adult and pediatric patients, bowel perforation is an infrequent and life-threatening side effect of temsirolimus in adults and has not previously been reported in children. We present a child treated with temsirolimus for recurrent metastatic rhabdomyosarcoma who underwent ileocecectomy and small bowel resection for perforation with frank necrosis. His presentation was complicated by Clostridium septicum infection, a rare, frequently fatal, gastrointestinal pathogen associated with malignancy and bowel ischemia.