Gas in the myocardium: a fatal presentation of Clostridium perfringens: a case report

Abstract

Background Clostridium perfringens is a well-known cause of gas gangrene with a very high mortality rate. Multiple cases of internal organs have been reported in the literature; however, non-traumatic spontaneous gas gangrene due to Clostridium perfringens with solely cardiac involvement in a patient without any risk factors has not been reported before. Case Summary A 52-year-old male presented to the emergency department with chest pain and exertional dyspnea for 3 days. The patient was hemodynamically stable initially, and the physical examination was unremarkable. Initial laboratory workup revealed elevated d-dimer and troponin levels. Computerized tomography (CT) of the chest was negative for pulmonary embolism but showed a hypodense focus in the cardiac silhouette. Acute coronary syndrome protocol was initiated; however, invasive cardiac workup was negative. The patient had rapid clinical deterioration with development of respiratory failure, shock and multiorgan failure within 24 hours. A transesophageal echocardiogram demonstrated an abnormal echogenic focus, corresponding to CT chest area. Despite aggressive treatment, the patient passed away within 36 hours. Later, the patient’s blood culture grew clostridium perfringens. A limited autopsy showed an abscess cavity in the interventricular septum, pathology of which revealed acute myocarditis and fibrinous pericarditis. Discussion Unlike other reported cases of C. perfringens with cardiac abscess, our patient had no known risk factors, and no other organs were involved. We conclude from this case that an air focus on the CT scan in the myocardium can be suggestive of a spontaneous gas gangrene of the myocardium, and the patients should be treated accordingly.

Binary Enterotoxin Producing Clostridium perfringens Isolated in Blood Cultures: Case Report and Review of the Literature

“…In humans, this bacterium is responsible for necrotizing gangrene, bacteremia in cancer patients or in patients with gastrointestinal tract infection, antibiotic-associated diarrhea, and infection after chemoembolization. Gas gangrene is the most frequent manifestation of C. perfringens infection and is one of the fatal manifestations that present after trauma or gastrointestinal surgeries [ 2 , 3 , 4 , 5 , 6 , 7 ].…”