Clostridium Perfringens Sepsis With Massive Intravascular Haemolysis: A Rare Presentation

Abstract

Massive intravascular haemolysis is a rare but well-known complication of Clostridium perfringens sepsis. Presence of fever, intravascular haemolysis, numerous spherocytes in peripheral blood smear and septic shock should raise this clinical suspicion. We describe the case of a 66-year-old male who was admitted in the Emergency Room complaining of abdominal pain, vomiting, fever and dark red urine. No relevant findings in physical examination were found. Laboratory tests revealed massive intravascular haemolysis (minimum haemoglobin of 4 g/dL). Ultrasound of the upper abdomen did not show relevant findings. Six hrs later his clinical condition suddenly deteriorated, evolving to septic shock. He was promptly admitted in the Intensive Care Unit but his condition continued to deteriorate very rapidly, with severe multiple organ failure. He died a few hrs later despite full organ support and large spectrum antibiotic therapy. Clostridium perfringens was identified in blood cultures taken before death. The post-mortem evaluation revealed a high stage of body decomposition suggesting presence of gas-producing bacteria precluding the execution of the autopsy. Though this is a very rare clinical condition, the suspicion of clostridium sepsis mandates the immediate prescription of antibiotic therapy and aggressive focus control in order to change the dismal prognosis associated with this entity.

Hematological investigations in a case of intravascular hemolysis due to Clostridium perfringens infection

“…The main takeaways of our investigation lie in RBC parameters and peripheral blood smear findings which are very consistent with the ones found in the reviewed literature, research, and case studies. As in our case severe hemolytic anemia, the presence of spherocytes, ghost cells, and vacuolated neutrophils with evident left shift and without evidence of schistocytes or parasites in peripheral blood smears are a repeating motif in most of the reviewed cases and should unequivocally raise suspicion of C. perfringens infection ( 3 , 4 , 8 , 16 - 21 ). The possibility of finding gram-positive bacilli in the direct gram stain of a patient’s peripheral blood or even bacilli englobed by neutrophil in a regular Giemsa-stained peripheral blood smear was reported but only vacuolated neutrophils in our study were observed ( 8 , 16 ).…”

Black Urine and Methemoglobinemia in the Setting of Sepsis Due to Clostridium Perfringens

“…Without early detection, source control, and antibiotics administration, the course of C. Perfringens septicemia can be rapidly fatal. 1,3,4 We present a case of an unfortunate 50 years old man who was found to have C. Perfringens septicemia early after he died from massive hemolysis and highlight the importance of early consideration of massive hemolysis as part of the differential diagnosis when faced with a critically ill patient presenting with a remarkably black-colored urine and mild methemoglobinemia.…”

“…Clostridium Perfringens (C. Perfringens) is an anaerobic gram-positive bacillus that can be present in the human gastrointestinal and genital tracts. 1 C. Perfringens septicemia most commonly occurs in patients who are immunocompromised. There are 5 biotypes of C. Perfringens, based on the type of toxin that is produced: type A, B, C, D, and E. 2 Alpha toxin, which is produced by all C. Perfringens types, is responsible for gas gangrene and myonecrosis in infected tissues; this toxin also possesses hemolytic activity by functioning as an enzyme that splits lecithin into phosphocholine and diglyceride, leading to the development of spherocytosis and interference with the functional integrity of the red blood cell (RBC) membrane and resulting in anemia, jaundice, and in rare cases, massive hemolysis.…”

“…Without early detection, source control, and antibiotics administration, the course of C. Perfringens septicemia can be rapidly fatal. 1,3,4…”

“…5 Massive intravascular hemolysis is a rare but described complication of C. Perfringens septicemia. 1 The disease can be deceptive as patients may not appear to be severely ill, and may be hemodynamically stable, yet decompensate very quickly. Without early detection, source control, and antibiotics administration, the course of C. Perfringens septicemia can be rapidly fatal.…”