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Kwon, Kim, Uh, Hwang, Kim, and Yoon: A Case of Clostridium perfringens Septicemia with Fatal Hemolytic Complication
Original Article

Korean J Leg Med 2006;26(5):358-361.

Published online: 10 February 2006

DOI: https://doi.org/10.3343/kjlm.2006.26.5.358

A Case of Clostridium perfringens Septicemia with Fatal Hemolytic Complication

Ohgun Kwon, M.D.1, Ho Young Kim, M.D.2, Young Uh, M.D.1, Gyu Yel Hwang, M.T.1, Hyo Youl Kim, M.D.2, Kap Jun Yoon, M.D.1

1Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

2Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

Received 10 November 2005       Revised 9 August 2006       Accepted 9 August 2006

Copyright © 2006 The Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Massive intravascular hemolysis secondary to Clostridium perfringens septicemia is rare but often fatal. We report a case of a fatal clostridial hemolytic complication in a 71-year-old woman with probable refractory anemia. The patient was admitted to the emergency room due to a comatose mental state and a high fever. Laboratory analysis showed massive hemolysis. She died from severe anemia two hours after admission. The next day, blood cultures grew gram positive cocci and boxcarshaped gram positive rods, which were identified as coagulase-negative staphylococci and C. perfringens, respectively.

Keywords: Clostridium perfringens, Massive hemolysis, Septicemia

References

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Fig. 1.
Peripheral blood smear showed rare intact red cells with spherocytes, and occasional rod-shaped microorganisms (× 1,000). But it was not determined whether the microorganisms were pathogens or contaminants.
kjlm-26-358f1.tif
Fig. 2.
Colonies grown on blood agar plate showed double zone hemolysis, which comprised an inner zone of complete hemolysis and an outer zone of incomplete hemolysis.
kjlm-26-358f2.tif
Table 1.
Results of laboratory tests except complete blood count
Tests Results Reference ranges Units
Prothrombin time 56.4 10.8–13.9 sec
INR 9.15 0.64–1.17  
aPTT 240 27–4 sec
Sodium 136 136–145 mmol/L
Potassium 6.4 3.5–5.1 mmol/L
Chloride 114 98–107 mmol/L
AST 368 <35 IU/L
ALT 24 <35 IU/L
Total bilirubin 9.7 <1.3 mg/dL
Direct bilirubin 7.0 <0.3 mg/dL
BUN 22 <20 mg/dL
Creatinine 1.4 <1.2 mg/dL
Glucose 101 80–115 mg/dL
pH 6.83 7.35–7.45  
PO2 267 72.0–104.0 mmHg
PCO2 16 32.0–45.0 mmHg
DAT Negative    
IAT Negative    
Urine protein Positive (4+)    
Urine RBC 5–9 0–2 /HPF
Urine nitrite Positive (1+)    
Urine bilirubin Positive (1+)    

Abbreviations: INR, international normalized ratio; aPTT, activated partial thromboplastin time; AST, aspartate aminotransferase; ALT, alanine aminotransferase; BUN, blood urea nitrogen; DAT, direct antiglobulin test; IAT, indirect antiglobulin test; RBC, red blood cell.

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