Postmortem Diagnosis of Clostridium Without Culture Confirmation

We report 3 individuals with clostridial sepsis, 2 culture-confirmed and 1 assumed based on historical information and autopsy findings. Case 1: a 46-year-old man with history of colon cancer status postcolectomy was found unresponsive and rapidly developed decompositional changes. At autopsy, within 1 day of his death, he had marked gaseous distention of the scrotum and palpable crepitance from the eyes to the feet, with bullae formation in the suprapubic region and left thigh. Postmortem culture of bullae fluid grew Clostridium septicum. Case 2: a 63-year-old woman with history of non-Hodgkin's lymphoma who was identified to have Clostridium perfringens by hospital cultures. Autopsy was performed the day after death. The skin had a generalized red-tan discoloration. The liver had large gas pockets in the parenchyma. Microscopic examination revealed bacterial rods. Other than diverticulosis and mild coronary artery atherosclerosis, no other disease process was identified. Case 3: a 34-year-old man was found dead in his apartment, which was 68°F, just under 1 day after having last been known alive. He was cooled before autopsy and autopsied less than 24 hours after being found. He had fixed anterior lividity, an abdomen that was distended by gas formation, and a scrotum that was distended by gas formation. There was no green discoloration of the abdomen. Glomerular capillaries contained bacterial rods with terminal spores. Because no other cause was identified, the cause of death was certified as probable clostridial sepsis.