Abstract
Clostridium sordelli infection is a rare but potentially lethal infection associated with abortions, injury, contaminated wounds, and illicit drug use. It causes a recognizable syndrome with marked leukocytosis. Rapid diagnosis and aggressive sepsis management is required for optimal outcome. We report a case in a trauma patient with delayed presentation after sustaining facial trauma with soil contamination. The critical care management is summarized and a review of the literature.
Highlights
We are reporting a case of malignant edema secondary to Clostridium sordelli infection in a trauma patient after blunt trauma to the face
On hospital day five cultures grew out Methicillin/Oxacillin resistant staphylococcus aureus (MRSA) and Candida parapsilosis and caspofungin was step downed to fluconazole along with the continuation of linezolid and pipercillin/tazobactam
Clostridium sordelli was originally described by Dr Alfredo Sordelli in South America in 1922 as Bacillus oedematic sporogenes due to the shared pathogenicity of B. oedematiens and the morphologic and cultural properties of B sporogenes [1]
Summary
We are reporting a case of malignant edema secondary to Clostridium sordelli infection in a trauma patient after blunt trauma to the face. The patient returned a day later with increasing facial edema, right eye pain and difficulty breathing. The patient was intubated for airway protection, started on empiric vancomycin, clindamycin and piperacillin/tazobactam and transferred to our tertiary center On arrival he was noted to have bilateral facial swelling, 1.5 cm wound on the right forehead, ecchymosis to the right cheek and right periorbital region and generalized pitting edema over the entire neck and face extending down to the neck and upper chest. On hospital day five cultures grew out MRSA and Candida parapsilosis and caspofungin was step downed to fluconazole along with the continuation of linezolid and pipercillin/tazobactam. The patient received twelve days of appropriate coverage with pipercillin/tazobactam for klebsiella pneumonia and clostridium sordelli, MRSA coverage with vancomycin and linezolid, and antifungal therapy with caspofungin and fluconazole. Pathological assessment of the debrided tissue showed focally ulcerated skin with necrosis and marked acute inflammation involving dermis, subcutaneous tissue and skeletal muscle with vascular thrombosis and inflammatory exudate
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