Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2020.185
Autopsy and Case Reports
Autopsy Case Report

Sudden death caused by Clostridium perfringens sepsis presenting as massive intravascular hemolysis

Katsuya Chinen

Downloads: 0
Views: 27

Abstract

An 80-year-old Japanese woman with diabetes mellitus was admitted with gastrointestinal symptoms and pyrexia. At presentation, liver abscesses and severe hemolytic anemia were noted. Before detailed diagnostic evaluation and adequate treatment, she suddenly died 2.5 hours after admission. The autopsy and bacteriological examinations revealed liver abscesses and massive intravascular hemolysis caused by Clostridium perfringens as well as other miscellaneous critical pathological findings, including acute renal tubular necrosis, lung edema, and pulmonary fat embolism. In this article, the detailed autopsy results are described and clinicopathologic characteristics on Clostridium perfringens-related sudden death are discussed with a review of the literature.

Keywords

Clostridium perfringens, Sepsis, Hemolysis, Embolism, Fat, Death, Sudden

References

Singer AJ, Migdal PM, Oken JP, Chale SN, Moll UM. Clostridium perfringens septicemia with massive hemolysis in a patient with Hodgkin’s lymphoma. Am J Emerg Med. 1997;15(2):152-4. [https://doi.org/10.1016/S0735-6757(97)90088-7]. [PMID:9115516]

Kreidl KO, Green GR, Wren SM. Intravascular hemolysis from a Clostridium perfringens liver abscess. J Am Coll Surg. 2002;194(3):387. [https://doi.org/10.1016/S1072-7515(01)01169-3]. [PMID:11893140]

Stevens DL, Bryant AE. The role of clostridial toxins in the pathogenesis of gas gangrene. Clin Infect Dis. 2002;35(Suppl 1):S93-100. [https://doi.org/10.1086/341928]. [PMID:12173116]

Kapoor JR, Monteiro B, Tanoue L, Siegel MD. Massive intravascular hemolysis and a rapidly fatal outcome. Chest. 2007;132(6):2016-9. [https://doi.org/10.1378/chest.07-0853]. [PMID:18079238]

Finsterer J, Hess B. Neuromuscular and central nervous system manifestations of Clostridium perfringens infections. Infection. 2007;35(6):396-405. [https://doi.org/10.1007/s15010-007-6345-z]. [PMID:18034207]

Smith LDS. Virulence factors of Clostridium perfringens. Rev Infect Dis. 1979;1(2):254-62. [https://doi.org/10.1093/clinids/1.2.254]. [PMID:232935]

Becker RC, Giuliani M, Savage RA, Weick JK. Massive hemolysis in Clostridium perfringens infections. J Surg Oncol. 1987;35(1):13-8. [https://doi.org/10.1002/jso.2930350104]. [PMID:2883342]

Burke MP, Opeskin K. Nontraumatic clostridial myonecrosis. Am J Forensic Med Pathol. 1999;20(2):158-62. [https://doi.org/10.1097/00000433-199906000-00011]. [PMID:10414657]

Hübl W, Mostbeck B, Hartleb H, Pointner H, Kofler K, Bayer PM. Investigation of the pathogenesis of massive hemolysis in a case of Clostridium perfringens septicemia. Ann Hematol. 1993;67(3):145-7. [https://doi.org/10.1007/BF01701741]. [PMID:8373904]

Jones TK, O’Sullivan DA, Smilack JD. 66-year-old woman with fever and hemolysis. Mayo Clin Proc. 1996;71(10):1007-10. [https://doi.org/10.1016/S0025-6196(11)63777-4]. [PMID:8820778]

Cochrane J, Bland L, Noble M. Intravascular hemolysis and septicemia due to Clostridium perfringens emphysematous cholecystitis and hepatic abscesses. Case Rep Med. 2015;2015:523402. [https://doi.org/10.1155/2015/523402]. [PMID:26229537]

Bätge B, Filejski W, Kurowski V, Klüter H, Djonlagic H. Clostridial sepsis with massive intravascular hemolysis: rapid diagnosis and successful treatment. Intensive Care Med. 1992;18(8):488-90. [https://doi.org/10.1007/BF01708587]. [PMID:1289375]

Ng H, Lam SM, Shum HP, Yan WW. Clostridium perfringens liver abscess with massive haemolysis. Hong Kong Med J. 2010;16(4):310-2. [PMID:20683077]

Rajendran G, Bothma P, Brodbeck A. Intravascular haemolysis and septicemia due to Clostridium perfringens liver abscess. Anaesth Intensive Care. 2010;38(5):942-5. [https://doi.org/10.1177/0310057X1003800522]. [PMID:20865884]

Loran MJ, McErlean M, Wilner G. Massive hemolysis associated with Clostridium perfringens sepsis. Am J Emerg Med. 2006;24(7):881-3. [https://doi.org/10.1016/j.ajem.2006.03.002]. [PMID:17098117]

Ohtani S, Watanabe N, Kawata M, Harada K, Himei M, Murakami K. Massive intravascular hemolysis in a patient infected by Clostridium perfringens. Acta Med Okayama. 2006;60(6):357-60. [PMID:17189980]

Solis DR, Hemming AW, Reed A, Van der Werf WJ, Fujita S, Howard RJ. Clostridial infection in a liver transplant recipient. Clin Transplant. 2004;18(6):726-8. [https://doi.org/10.1111/j.1399-0012.2004.00134.x]. [PMID:15516251]

Craven CM. Fatal Clostridium perfringens septicemia associated with gastrointestinal arteriovenous malformations (vascular ectasias). Arch Pathol Lab Med. 1989;113(5):534-5. [PMID:2540727]

Rogstad B, Ritland S, Lunde S, Hagen AG. Clostridium perfringens septicemia with massive hemolysis. Infection. 1993;21(1):54-6. [https://doi.org/10.1007/BF01739316]. [PMID:8449584]

Boyd SD, Mobley BC, Regula DP, Arber DA. Features of hemolysis due to Clostridium perfringens infection. Int J Lab Hematol. 2009;31(3):364-7. [https://doi.org/10.1111/j.1751-553X.2007.01018.x]. [PMID:18177433]

Martí Gelonch L, Jiménez Agüero R, Rodríguez Canas N, Enríquez Navascués JM. Massive haemolysis due to sepsis caused by Clostridium perfringens secondary to liver abscess. Presentation of two cases with a similar history. Gastroenterol Hepatol. 2018;41(9):562-3. [PMID:29455931]

Gutiérrez A, Florencio R, Ezpeleta C, Cisterna R, Martínez M. Fatal intravascular hemolysis in a patient with Clostridium perfringens septicemia. Clin Infect Dis. 1995;20(4):1064-5. [https://doi.org/10.1093/clinids/20.4.1064]. [PMID:7795054]

Tsai IK, Yen MY, Ho IC, Yu KW, Liu CY, Cheng DL. Clostridium perfringens septicemia with massive hemolysis. Scand J Infect Dis. 1989;21(4):467-71. [https://doi.org/10.3109/00365548909167454]. [PMID:2555910]

Pun KC, Wehner JH. Abdominal pain and massive intravascular hemolysis in a 47-year-old man. Chest. 1996;110(5):1353-5. [https://doi.org/10.1378/chest.110.5.1353]. [PMID:8915246]

Alvarez A, Rives S, Nomdedeu B, Pereira A. Massive hemolysis in Clostridium perfringens infection. Haematologica. 1999;84(6):571-3. [PMID:10366812]

Van Bunderen CC, Bomers MK, Wesdorp E, Peerbooms P, Veenstra J. Clostridium perfringens septicemia with massive intravascular haemolysis: a case report and review of the literature. Neth J Med. 2010;68(9):343-6. [PMID:20876913]

Govan ADT. An account of the pathology of some cases of Cl. welchii infection. J Pathol Bacteriol. 1946;58(3):423-30. [https://doi.org/10.1002/path.1700580312]. [PMID:20283078]

Chinen K, Ito K. Sudden death caused by pulmonary fat embolism in a patient with miliary tuberculosis. Autops Case Rep. 2019;9(1):e2018059. [https://doi.org/10.4322/acr.2018.059]. [PMID:30863732]

Lazarescu C, Kimmoun A, Blatt A, Bastien C, Levy B. Clostridium perfringens gangrenous cystitis with septic shock and bone marrow necrosis. Intensive Care Med. 2012;38(11):1906-7. [https://doi.org/10.1007/s00134-012-2647-4]. [PMID:22797355]

Voisard MX, Schweitzer W, Jackowski C. Pulmonary fat embolism: a prospective study within the forensic autopsy collective of the Republic of Iceland. J Forensic Sci. 2013;58(Suppl 1):S105-11. [https://doi.org/10.1111/1556-4029.12003]. [PMID:23106443]

Poulou A, Manolis EN, Markou F, Ropotos A, Georgiadis M, Tsakris A. Fatal massive hemolysis as the first manifestation of Clostridium perfringens septicemia in a patient with non-systematic or local predisposing disorder. Anaerobe. 2007;13(1):40-2. [https://doi.org/10.1016/j.anaerobe.2006.11.004]. [PMID:17222573]

Simon TG, Bradley J, Jones A, Carino G. Massive intravascular hemolysis from Clostridium perfringens septicemia: a review. J Intensive Care Med. 2014;29(6):327-33. [https://doi.org/10.1177/0885066613498043]. [PMID:24019300]

Smith LP, McLean APH, Maughan GB. Clostridium welchii septicotoxemia. A review and report of 3 cases. Am J Obstet Gynecol. 1971;110(1):135-49. [https://doi.org/10.1016/0002-9378(71)90235-3]. [PMID:4324790]

Nadisauskiene RJ, Kliucinskas M, Vitkauskiene A, Minkauskiene M, Vaitkiene D. Puerperal Clostridium perfringens sepsis in a patient with granulocytopenia. Gynecol Obstet Invest. 2008;65(1):32-4. [https://doi.org/10.1159/000106763]. [PMID:17675887]

Barrett JP, Whiteside JL, Boardman LA. Fatal clostridial sepsis after spontaneous abortion. Obstet Gynecol. 2002;99(5 Pt 2):899-901. [PMID:11975951]

Bodey GP, Rodriguez S, Fainstein V, Elting LS. Clostridial bacteremia in cancer patients: a 12-year experience. Cancer. 1991;67(7):1928-42. [https://doi.org/10.1002/1097-0142(19910401)67:7<1928::AID-CNCR2820670718>3.0.CO;2-9]. [PMID:2004306]

Vaiopoulos G, Calpadaki C, Sinifakoulis H, et al. Massive intravascular hemolysis: a fatal complication of Clostridium perfringens septicemia in a patient with acute myeloid leukemia. Leuk Lymphoma. 2004;45(10):2157-9. [https://doi.org/10.1080/10428190410001697331]. [PMID:15370265]

Pirrotta MT, Bucalossi A, Forconi F, et al. Massive intravascular hemolysis: a fatal complication of Clostridium perfringens septicemia in a patient with acute lymphoblastic leukemia. Leuk Lymphoma. 2005;46(5):793. [https://doi.org/10.1080/10428190500032687]. [PMID:16019522]

Ifthikaruddin JJ, Holmes JA. Clostridium perfringens septicaemia and massive intravascular haemolysis as a terminal complication of autologous bone marrow transplant. Clin Lab Haematol. 1992;14(2):159-61. [https://doi.org/10.1111/j.1365-2257.1992.tb01074.x]. [PMID:1633687]

Watt J, Amini A, Mosier J, et al. Treatment of severe hemolytic anemia caused by Clostridium perfringens sepsis in a liver transplant recipient. Surg Infect (Larchmt). 2012;13(1):60-2. [https://doi.org/10.1089/sur.2010.092]. [PMID:22316146]

Bush GW, Clements RH, Phillips M, Kent RB Jr. Clostridium perfringens sepsis with intravascular hemolysis following laparoscopic cholecystectomy: a newly reported complication. Am Surg. 1996;62(4):326-7. [PMID:8600858]

Uojima H, Onoue M, Hidaka H, et al. A suspected case of Clostridium perfringens sepsis with intravascular hemolysis after transhepatic arterial chemoembolization: a case report. J Med Case Rep. 2019;13(1):125. [https://doi.org/10.1186/s13256-019-2023-x]. [PMID:31027514]

Alvarez-Elcoro S, Sifuentes-Osorio J. Clostridium perfringens bacteremia in prosthetic valve endocarditis. Diagnosis by peripheral blood smear. Arch Intern Med. 1984;144(4):849-50. [https://doi.org/10.1001/archinte.1984.00350160219037]. [PMID:6324707]

Bryant CS, Perry L, Shah JP, Kumar S, Deppe G. Life-threatening clostridial sepsis in a postmenopausal patient with degenerating uterine leiomyoma. Case Rep Med. 2010;2010:541959. [https://doi.org/10.1155/2010/541959]. [PMID:20585368]

Hamoda H, Chamberlain PF. Clostridium welchii infection following amniocentesis: a case report and review of the literature. Prenat Diagn. 2002;22(9):783-5. [https://doi.org/10.1002/pd.409]. [PMID:12224071]

Meyerhoff A, Renzi RM, Wehbe T, Opal SM. Fatal clostridial sepsis in a previously healthy woman. Clin Infect Dis. 1995;20(4):1066-7. [https://doi.org/10.1093/clinids/20.4.1066]. [PMID:7795055]

Gerber JE. Acute necrotizing bacterial tonsillitis with Clostridium perfringens. Am J Forensic Med Pathol. 2001;22(2):177-9. [https://doi.org/10.1097/00000433-200106000-00013]. [PMID:11394754]

Smith AM, Thomas J, Mostert PJH. Fatal case of Clostridium perfringens enteritis and bacteremia in South Africa. J Infect Dev Ctries. 2011;5(5):400-2. [https://doi.org/10.3855/jidc.1602]. [PMID:21628819]

Sweeting J, Rosenberg L. Primary clostridial pneumonia. Ann Intern Med. 1959;51(4):805-10. [https://doi.org/10.7326/0003-4819-51-4-805]. [PMID:13836083]

Keese M, Nichterlein T, Hahn M, et al. Gas gangrene pyaemia with myocardial abscess formation: fatal outcome from a rare infection nowadays. Resuscitation. 2003;58(2):219-25. [https://doi.org/10.1016/S0300-9572(03)00121-7]. [PMID:12909385]

Subramaniam K, Hasmi AH, Mahmood MS. Clostridial aortitis causing ruptured dissecting aneurysm in a young adult female. Malays J Pathol. 2014;36(3):213-6. [PMID:25500522]

Königsrainer I, Kurth R, Haack B, et al. Sudden death after pancreatic head resection: rupture of hepatic artery caused by clostridial infection. Surg Infect (Larchmt). 2007;8(6):615-9. [https://doi.org/10.1089/sur.2006.068]. [PMID:18171122]

With M. Cerebral gas embolism caused by Clostridium perfringens: report of a case. Rontgenpraxis. 1998;51(10):369-72. [PMID:9885537]

Kristopaitis T, Jensen R, Gujrati M. Clostrdium perfringens: a rare cause of postoperative spinal surgery meningitis. Surg Neurol. 1999;51(4):448-50. [https://doi.org/10.1016/S0090-3019(97)00454-0]. [PMID:10199301]

Chinen K, Ohkura Y, Matsubara O, Tsuchiya E. Hemophagocytic syndrome associated with clostridial infection in a pancreatic carcinoma patient. Pathol Res Pract. 2004;200(3):241-5. [https://doi.org/10.1016/j.prp.2004.01.006]. [PMID:15200276]

Stevens DL, Aldape MJ, Bryant AE. Life-threatening clostridial infections. Anaerobe. 2012;18(2):254-9. [https://doi.org/10.1016/j.anaerobe.2011.11.001]. [PMID:22120198]

Glastonbury JRW, Searson JE, Links IJ, Tuckett LM. Clostridial myocarditis in lambs. Aust Vet J. 1988;65(7):208-9. [https://doi.org/10.1111/j.1751-0813.1988.tb14459.x]. [PMID:3421885]

Zhu L, Zhou W, Wang T, et al. Isolation of Clostridium perfringens type A from wild bharals (Pseudois nayaur) following sudden death in Tibet, China. Anaerobe. 2017;44:20-2. [https://doi.org/10.1016/j.anaerobe.2017.01.004]. [PMID:28082244]

Hausmann R, Albert F, Geißdörfer W, Betz P. Clostridium fallax associated with sudden death in a 16-year-old boy. J Med Microbiol. 2004;53(Pt6):581-3. [https://doi.org/10.1099/jmm.0.05495-0]. [PMID:15150341]

 

 

 


Submitted date:
04/24/2020

Accepted date:
05/24/2020

Publication date:
07/30/2020

5f2321770e88257318e56d7d autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections