Clostridium Perfringens Infection in a Febrile Patient with Severe Hemolytic Anemia

Abstract

Background: Clostridium perfringens (C. perfringens) can cause various infections, including gas gangrene, crepitant cellulitis, and fasciitis. While C. perfringens sepsis is uncommon, it is often rapidly fatal because the alpha toxin of this bacterium induces massive intravascular hemolysis by disrupting red blood cell membranes.

Case report: We present the case of a male patient with diabetes who developed a fatal liver abscess with massive intravascular hemolysis and septic shock caused by toxigenic C. perfringens. The peripheral blood smear showed loss of central pallor, with numerous spherocytes. Multiplex PCR only detected expression of the cpa gene, indicating that the pathogen was C. perfringens type A.

Conclusions: C. perfringens infection should be considered in a febrile patient who has severe hemolytic anemia with a very low MCV, hemolyzed blood sample, and negative Coombs test. The characteristic peripheral blood smear findings may facilitate rapid diagnosis.

Figure 1.

Abdominal computed tomography shows a gas-filled abscess in the left lobe of the liver, as well as emphysematous cholecystitis and pneumobilia.

Figure 2.

Peripheral blood smear using the sample collected in the ER of the local hospital. Note that there is marked anisocytosis (red cells of varying sizes), spherocytosis (red arrows), nucleated red blood cells (blue arrows), and dehemoglobinized ghost cells (green arrow).

Figure 3.

Agarose gel electrophoresis of PCR products. Lane 1 is the 100 bp DNA ladder; Lane 2 is positive controls for α, β, and τ toxins; Lane 3 is the negative control; Lanes 4 and 5 are PCR products extracted from 1 and 5 colonies of C. perfringens; and Lane 6 is positive controls for enterotoxin and ɛ and β2 toxins. The arrow indicates α toxin.