Abstract
Clostridium perfringens bacteremia is an uncommon yet serious clinical syndrome that typically arises from a gastrointestinal source. However, clinicians should consider nongastrointestinal sources as well. We present a rare case of C. perfringens bacteremia of urinary origin that required surgical intervention for definitive treatment. A 61-year-old male presented with acute nausea and vomiting, altered mental status, and chronic diarrhea. His physical exam revealed right costovertebral tenderness and his laboratory work-up revealed acute renal failure. Percutaneous blood cultures grew C. perfringens. Cross-sectional imaging revealed a right-sided ureteral stone with hydronephrosis, which required nephrostomy placement. On placement of the nephrostomy tube, purulent drainage was identified and Gram stain of the drainage revealed Gram-variable rods. A urinary source of C. perfringens was clinically supported. Although it is not a common presentation, nongastrointestinal sources such as a urinary source should be considered in C. perfringens bacteremia because failure to recognize a nongastrointestinal source can delay appropriate treatment, which may include surgical intervention.
Highlights
Clostridium species are ubiquitous, spore-forming bacteria that are commonly found in the soil and sewage
We present a case of an elderly male with C. perfringens bacteremia from a urinary source that required surgical intervention for infectious source control
A PubMed search of the English-language literature was performed in December 2015 using the MeSH term “Clostridium perfringens” with each of the following MeSH terms: “bacteremia,” “cystitis,” and “pyelonephritis.” The systematic review revealed 15 cases of urinary tract infections due to C. perfringens
Summary
Clostridium species are ubiquitous, spore-forming bacteria that are commonly found in the soil and sewage. Clostridium perfringens, the most commonly isolated Clostridium species, is an anaerobic Gram-positive rod that is found in the gastrointestinal tract, in the female genital tract, and less frequently on the skin [1]. C. perfringens bacteremia carries significant mortality with reported mortality rates ranging from 27 to 58%, and it is important to treat it correctly and promptly [2,3,4,5,6,7,8]. Urinary tract infections due to C. perfringens have been documented in the literature but are considered rare [3,4,5, 10,11,12,13,14,15,16,17,18,19]. We present a case of an elderly male with C. perfringens bacteremia from a urinary source that required surgical intervention for infectious source control
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