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Clostridium perfringens-Induced Emphysematous Pyelonephritis: A Diagnostic Challenge With Negative Urine Culture
Chisato Nakajima1, Masahiro Kashiura1, Shiho Togo1
1Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, JPN.
Cureus
|August 20, 2025
Summary
Clostridium perfringens, a rare cause of urinary tract infections, can present challenges due to its anaerobic nature. This case highlights its potential role in healthcare-associated infections, especially in high-risk patients.
Area of Science:
- Infectious Diseases
- Microbiology
- Urology
Background:
- Clostridium perfringens is an uncommon cause of urinary tract infections (UTIs).
- Anaerobic bacteria pose diagnostic challenges in clinical microbiology.
- Healthcare-associated UTIs are a significant concern in vulnerable patient populations.
Observation:
- A 59-year-old woman with diabetes and cervical cancer developed fever and dyspnea post-ureteral stent placement.
- Clinical signs included costovertebral angle tenderness and dark red urine.
- Laboratory findings revealed hemolysis, renal dysfunction, and positive blood cultures for C. perfringens, despite negative urine cultures.
Findings:
- Computed tomography showed gas in the renal pelvis, suggesting gas-forming organism involvement.
- The patient experienced circulatory collapse, necessitating intensive care.
- Prompt antimicrobial therapy and stent replacement led to stabilization and recovery.
Implications:
- This case underscores C. perfringens as a potential pathogen in healthcare-associated UTIs, particularly in immunocompromised or instrumented patients.
- Negative urine cultures in the presence of infection highlight the need for anaerobic culture techniques.
- Intravascular hemolysis and unusual UTI presentations warrant consideration of anaerobic pathogens in at-risk individuals.
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