Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report

Masahide Sakaue,Masahiro Oka,Shinya Yonogi,Masahiko Nitta,Eriko Nakamura,Yasuo Oishi,Akira Takasu,Koshi Ota,Yohei Sano

doi:10.1186/s12879-019-4350-3

Abstract

BackgroundClostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and fasciitis. C. perfringens septicemia is rare, but is a known cause of hemolysis by damaging red blood cell, and often proves rapidly fatal in emergency department (ED) situations.Case presentationA previously healthy 76-year-old man presented to the ED 8 h after onset of acute abdominal pain and diarrhea. Laboratory examination revealed a large discrepancy between the red blood cell count of 1.91 × 106/mm3 and the hemoglobin level of 10.3 g/dL, suggesting massive intravascular hemolysis. Computed tomography revealed liver abscesses with gas. During ED treatment, the state of the patient rapidly deteriorated and he entered cardiopulmonary arrest. Blood cultures finally identified C. perfringens.ConclusionIntravascular hemolysis and red blood cell (RBC) / hemoglobin (Hb) discrepancy in the presence of infection should prompt ED physicians to consider C. perfringens septicemia and to act quickly to provide appropriate treatment.

Highlights

Clostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and fasciitis
We report a case of fulminant C. perfringens septicemia with massive acute hemolysis and liver abscess
Despite rapid initiation of antibiotic therapy, the patient died within 3 h of admission to the emergency department (ED)

Summary

Introduction

Clostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and fasciitis. Conclusion: Intravascular hemolysis and red blood cell (RBC) / hemoglobin (Hb) discrepancy in the presence of infection should prompt ED physicians to consider C. perfringens septicemia and to act quickly to provide appropriate treatment. C. perfringens septicemia is a rare, but rapidly fatal disease with a reported mortality rate of at least 60% [1]. C. perfringens type A produces an α-toxin that induces hemolysis by destroying red blood cells, resulting in a failure to supply oxygen to tissues [2, 3].

Results

Conclusion