Paeniclostridium sordelliによる敗血症性流産後のトキシックショック症候群 - 事例報告

Paeniclostridium sordellii is a highly virulent, spore-forming, Gram-positive anaerobe responsible for life-threatening infections, including endocarditis, myositis, and toxic shock syndrome. Although less well known than other clostridial species, it poses a significant risk, particularly to postpartum women, intravenous drug users, and the immunocompromised. In recent times, clostridial sepsis with toxic shock syndrome is more commonly seen in patients who underwent medical abortion and IV drug users, with mortality as high as 70 % within a few days of symptom onset. Here, we present a case of severe toxic shock syndrome caused by P.sordellii in a young woman presenting 6 days after medical abortion, with a leukemoid reaction (max WBC 53,000/µL) and rapidly progressive shock due to Toxic shock syndrome (TSS). Despite initial medical management with broad-spectrum antibiotics and supportive care, she required hysterectomy for definitive source control and 29 days of hospitalization, including ECMO support for refractory shock. The hospital course was further complicated by acute kidney injury, anemia, thrombocytopenia and volume overload. A high degree of suspicion, the prompt initiation of broad-spectrum antibiotics, and timely source control are essential in preventing mortality.