Introduction: Clostridium perfringens is a gram positive bacilli associated with food poisoning. It is also known to cause a rare phenomenon called clostridial necrotizing enteritis (also known as pigbel). It is usually seen in Clostridium perfringens type C infection, which carries a high mortality and requires early identification and aggressive treatment. Case Summary: We present a case of a 68 year male who presented with 3-4 days history of nausea, abdominal cramping and diarrhea. He also had a few episodes of non-bilious non-bloody emesis with decreased appetite. He had eaten food including pork that was left out for some time in the microwave in the days leading up to symptoms. On presentation, his systolic blood pressures were in the 90s. His physical exam was significant for diffuse abdominal tenderness to palpation with mild distension, but no signs of peritonitis. Labs revealed acute kidney injury (Cr 1.96 mg/dl with baseline ˜1.3 mg/dl) and acidosis (HCO3 19 mEq/L). Abdominal xray showed a few mildly distended small bowel loops. Due to persistent symptoms, CT scan of the abdomen and pelvis was performed and showed moderate wall thickening and mild dilation of the proximal jejunum. MRA abdomen findings did not suggest mesenteric ischemia as an etiology. Stool cultures were negative for enteric pathogens. Push enteroscopy revealed severe diffuse ulcerative scalloped mucosa with overlying exudate beginning in the proximal jejunum and appeared to worsen distally. Histopathological findings of jejunal biopsies showed small bowel mucosa with extensive ulceration, marked acute and chronic inflammation, villous loss, and granulation tissue. Gram stain demonstrated gram positive large bacilli bacteria consistent with clostridium perfringens. Patient's symptoms gradually improved with supportive care and he was discharged from the hospital. Discussion: In this abstract, we present a rare but aggressive form of infectious diarrhea, clostridial necrotizing enteritis, caused by Clostridium perfringens. It is rarely seen in the United States with only few cases reported up to date. Clinical results may vary from mild diarrhea to a life-threatening disease. It related to consumption of pig meat and is thought to be caused by B-toxin of clostridium perfringens type C. Clostridium perfringens needs to be considered in all patients presenting with enteritis especially when they have signs of sepsis.Figure 1