[Fulminant Course of a Clostridium Perfringens Infection with Pathognomonic CT finding]

History and clinical findings A 74-year old woman was accepted by the emergency room with severe chest and abdominal pain. She complained about regurgitation after ingestion of food followed by sharp pain in her breast. Investigations A first examination of the patient showed a tachypnoea und tachycardia up to 122 beats per minute, the body temperature measured on admission was 38.7 °C. Due to hemolysis only a few of the requested parameters could be evaluated. CRP was increased with 8.32 mg/dl. The hemoglobin dropped from 12.0 g/dl to 10.3 g/dl during 4 hours. A computed tomography scan was done because of severe worsening of the patient's condition. The CT scan showed two cavities in the right lobe of the liver filled with gas. Treatment and course Initial antibiotic therapy with Ceftriaxon was immediately started. During her stay in the emergency room the patient showed a severe worsening of her condition. Therefore a CT scan was initiated after the abdominal ultrasound revealed nothing specific. During the CT examination the patient stopped breathing sufficiently, followed by hematuria and vomiting a large amount of blood. The patient died 8.5 hours of an irreversible cardiovascular failure after admission to the hospital. Conclusion A rapid decline of the patient's condition in addition to hemolysis and a gas-filled liver necrosis are pathognomonic signs for an infection with clostridium perfringens which requires immediate treatment. Only an immediate surgical intervention in combination with an adapted antibiotic increases chances of survival in patients with clostridia.