Clostridium perfringens Sepsis With Fulminant Intravascular Hemolysis: Diagnostic Clues From the Peripheral Blood...

Clostridium perfringens (C. perfringens) bacteremia complicated by massive intravascular hemolysis (MIH) is rare, rapidly progressive, and often fatal even before microbiological confirmation is available. We present the case of an 85-year-old man initially presenting with symptoms suggestive of an acute cardiovascular event. Within hours, however, his condition deteriorated significantly, necessitating intubation and admission to the ICU, while severe hemolysis repeatedly rendered his blood samples unsuitable for analysis. At that time, review of the patient's peripheral blood (PB) film revealed bacillary forms within a neutrophil, providing a significant, early clue to overwhelming toxin-mediated bacterial sepsis, later confirmed to be due to C. perfringens, which, despite broad-spectrum antibiotic treatment and intensive supportive care, led to the patient's death within hours of ICU admission. This report highlights the importance of urgent PB film review in septic patients with otherwise unexplained hemolysis, in order to enable a timely and effective antibiotic regimen, optimized supportive care, and assessment for source control when possible.