[Massive intravascular hemolysis secondary to sepsis due to Clostridium perfringens].
Massive hemolysis secondary to sepsis caused by Clostridium perfringens is a rare entity but appears fairly often in the literature. In nearly all published reports, the clinical course is rapid and fatal. We describe the case of a 75-year-old woman with diabetes who was admitted with symptoms consistent with acute cholecystitis. Deteriorating hemodynamics and laboratory findings were consistent with intravascular hemolysis, coagulation disorder, and renal failure. Gram-positive bacilli of the Clostridium species were detected in blood along with worsening indicators of hemolysis. In spite of antibiotic and surgical treatment, hemodynamic support and infusion of blood products, the patient continued to decline and died in the postoperative recovery unit 14 hours after admission. Mortality ranges from 70% to 100% in sepsis due to Clostridium perfringens, and risk of death is greater if massive hemolysis is present, as in the case we report. Only a high degree of clinical suspicion leading to early diagnosis and treatment can improve the prognosis. This bacterium should therefore be considered whenever severe sepsis and hemolysis coincide.
Pita Zapata
E
E
Servicio de Anestesiología y Reanimación, Hospital Arquitecto Marcide, Area Sanitaria de Ferrol, A Coruña. etxanizalvarez@hotmail.com
Sarmiento Penide
A
A
Bautista Guillén
A
A
González Cabano
M
M
Agulla Budiño
J A
JA
Camba Rodríguez
M A
MA
D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D000368:Aged; D000743:Anemia, Hemolytic / Q000209:etiology* / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D016913:Blood Component Transfusion; D002763:Cholecystectomy; D002764:Cholecystitis / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D002981:Clindamycin / Q000627:therapeutic use; D003016:Clostridium perfringens / Q000302:isolation & purification; D003131:Combined Modality Therapy; D057210:Delayed Diagnosis; D048909:Diabetes Complications; D004630:Emergencies; D017809:Fatal Outcome; D005260:Female; D005738:Gas Gangrene / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D006440:Hemofiltration; D006801:Humans; D000077731:Meropenem; D009638:Norepinephrine / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology; D012772:Shock, Septic / Q000209:etiology* / Q000628:therapy; D013845:Thienamycins / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D013845:Thienamycins; D002981:Clindamycin; D000077731:Meropenem; D009638:Norepinephrine