[Sepsis with intravascular hemolysis caused by Clostridium perfringens]

Clostridium perfringens is a gram-positive anaerobic rod commonly found in our natural environment as well as in human intestinal and vaginal microflora. Due to its production of several toxins it may cause numerous infections of varying degrees of severity. Bacteremia, albeit uncommon, is potentially lethal owing to the disruption of red blood cells leading to hemolysis and septic shock in which mortality is very high. Immunosuppression, malignancy and diabetes are the most common risk factors for developing bacteremia induced by C. perfringens.  The most effective treatment is most likely a combination of a beta-lactam antibiotic and clindamycin or metronidazole and, if possible, surgical drainage.  This case study presents a female 67-year old patient with undiagnosed diabetes who developed septic shock with massive intravascular hemolysis caused by C. perfringens. The status of the patient was rapidly deteriorating and death followed three hours after her arrival at the emergency department. An autopsy was performed during which a liver abscess was discovered and assessed to be the source of infection. Diabetes is a well-known risk factor for both liver abscess and C. perfringens infection.  Conclusively it can be stated that the combination of hemolysis and infection should lead to consideration of C. perfringens as the possible pathogen and thus immediate suitable antibiotic treatment must ensue.