Clostridium Perfringens Sepsis With Massive Intravascular Haemolysis: A Rare Presentation

Abstract

Massive intravascular haemolysis is a rare but well-known complication of Clostridium perfringens sepsis. Presence of fever, intravascular haemolysis, numerous spherocytes in peripheral blood smear and septic shock should raise this clinical suspicion. We describe the case of a 66-year-old male who was admitted in the Emergency Room complaining of abdominal pain, vomiting, fever and dark red urine. No relevant findings in physical examination were found. Laboratory tests revealed massive intravascular haemolysis (minimum haemoglobin of 4 g/dL). Ultrasound of the upper abdomen did not show relevant findings. Six hrs later his clinical condition suddenly deteriorated, evolving to septic shock. He was promptly admitted in the Intensive Care Unit but his condition continued to deteriorate very rapidly, with severe multiple organ failure. He died a few hrs later despite full organ support and large spectrum antibiotic therapy. Clostridium perfringens was identified in blood cultures taken before death. The post-mortem evaluation revealed a high stage of body decomposition suggesting presence of gas-producing bacteria precluding the execution of the autopsy. Though this is a very rare clinical condition, the suspicion of clostridium sepsis mandates the immediate prescription of antibiotic therapy and aggressive focus control in order to change the dismal prognosis associated with this entity. J Med Cases. 2012;3(3):207-210 doi: https://doi.org/10.4021/jmc583w