Systemic Clostridium toxicity resulting from a knee laceration in a child

Abstract

This report describes the clinical course and treatment of a C. perfringens infection in a child following an injury to the knee that resulted in sepsis and multi-organ system failure. Diagnosis of the causative agent and systemic nature of the infection was delayed because of the non-traditional presentation, in which the patient appeared to have a localized necrotizing fasciitis and did not display symptoms consistent with severe systemic involvement. He was treated with vancomycin, wound debridement and fasciotomy. After identification of C. perfringens, vancomycin therapy was discontinued in favor of penicillin and clindamycin. With intensive supportive care, the patient recovered fully and resumed regular activities within two months. These infections are rare in children, but they can be life threatening. It is important to include systemic Clostridium infection in a differential so it can be recognized early and appropriate treatment begun as soon as possible.