title: Fatal Clostridium perfringens septicemia suggested by postmortem computed tomography: A medico-legal autopsy case report.
abstract: We report a fatal case of suspected Clostridium (Cl.) perfringens septicemia in a previously healthy woman in her eighties. At first, she presented at the hospital complaining of upper abdominal discomfort and vomiting, and was discharged the next day after ruling out any fatal conditions. However, her condition deteriorated approximately 10h after discharge and she died shortly after. The postmortem computed tomography (PMCT) performed 29h postmortem revealed an excessive systemic gas accumulation compared with the postmortem external appearance and time elapsed since her death, which suggested the presence of a gas-forming infection. Histopathological examination showed diffuse proliferation of Gram-positive bacilli in almost all the organ tissues, especially in blood vessels. Along with these findings, hyperthermia 3h postmortem, and severe anemia and thrombocytopenia without an obvious site of hemorrhage suggested hemolysis due to Cl. perfringens septicemia. These findings suggested the diagnosis before performing the conventional autopsy. To the best of our knowledge, this is the first case report to describe PMCT findings of gas-forming infection and septicemia in contrast with the external appearance and histopathological findings in a medico-legal autopsy setting.
authors.affiliation: Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan. Electronic address: rymgch@m.u-tokyo.ac.jp.
authors.forename: Rutsuko
authors.initials: R
authors.lastname: Yamaguchi
authors.affiliation: Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan; Education and Research Center of Legal Medicine, Department of Forensic Radiology and Imaging, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan. Electronic address: ymakino-tky@umin.ac.jp.
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Makino
authors.affiliation: Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan. Electronic address: chibafumico@chiba-u.jp.
authors.forename: Fumiko
authors.initials: F
authors.lastname: Chiba
authors.affiliation: Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan. Electronic address: aama0171@chiba-u.jp.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Motomura
authors.affiliation: Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan. Electronic address: goinokuchi@chiba-u.jp.
authors.forename: Go
authors.initials: G
authors.lastname: Inokuchi
authors.affiliation: Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan. Electronic address: yajima.d@faculty.chiba-u.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yajima
authors.affiliation: Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan. Electronic address: iwase@faculty.chiba-u.jp.
authors.forename: Hirotatro
authors.initials: H
authors.lastname: Iwase
mesh_terms: D000369:Aged, 80 and over; D000740:Anemia / Q000382:microbiology; D003016:Clostridium perfringens; D017809:Fatal Outcome; D005260:Female; D005334:Fever / Q000382:microbiology; D049429:Forensic Pathology; D005738:Gas Gangrene / Q000000981:diagnostic imaging*; D006461:Hemolysis; D006801:Humans; D061330:Multidetector Computed Tomography; D018805:Sepsis / Q000382:microbiology*; D013921:Thrombocytopenia / Q000382:microbiology
keywords: Autopsy; Clostridium perfringens; Computed tomography; Gas gangrene; Postmortem examination; Septicemia