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06 April 2016 : Case report  Japan

Clostridium Perfringens Infection in a Febrile Patient with Severe Hemolytic Anemia

Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Masamitsu HashibaBCDE, Atsutoshi TominoBCD, Nobuyoshi TakenakaBCD, Tomonori HattoriBCD, Hideki KanoBCD, Masanobu TsudaBCD, Naoshi TakeyamaABCDEF

DOI: 10.12659/AJCR.895721

Am J Case Rep 2016; 17:219-223

Abstract

BACKGROUND: Clostridium perfringens (C. perfringens) can cause various infections, including gas gangrene, crepitant cellulitis, and fasciitis. While C. perfringens sepsis is uncommon, it is often rapidly fatal because the alpha toxin of this bacterium induces massive intravascular hemolysis by disrupting red blood cell membranes.

CASE REPORT: We present the case of a male patient with diabetes who developed a fatal liver abscess with massive intravascular hemolysis and septic shock caused by toxigenic C. perfringens. The peripheral blood smear showed loss of central pallor, with numerous spherocytes. Multiplex PCR only detected expression of the cpa gene, indicating that the pathogen was C. perfringens type A.

CONCLUSIONS: C. perfringens infection should be considered in a febrile patient who has severe hemolytic anemia with a very low MCV, hemolyzed blood sample, and negative Coombs test. The characteristic peripheral blood smear findings may facilitate rapid diagnosis.

Keywords: Anemia, Hemolytic - microbiology, Aged, 80 and over, Clostridium Infections - diagnosis, Clostridium perfringens, Fatal Outcome, Fever - microbiology, Liver Abscess - microbiology, Shock, Septic - microbiology

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923