title: Severe Sepsis due to Clostridium perfringens Bacteremia of Urinary Origin: A Case Report and Systematic Review.
abstract: Clostridium perfringens bacteremia is an uncommon yet serious clinical syndrome that typically arises from a gastrointestinal source. However, clinicians should consider nongastrointestinal sources as well. We present a rare case of C. perfringens bacteremia of urinary origin that required surgical intervention for definitive treatment. A 61-year-old male presented with acute nausea and vomiting, altered mental status, and chronic diarrhea. His physical exam revealed right costovertebral tenderness and his laboratory work-up revealed acute renal failure. Percutaneous blood cultures grew C. perfringens. Cross-sectional imaging revealed a right-sided ureteral stone with hydronephrosis, which required nephrostomy placement. On placement of the nephrostomy tube, purulent drainage was identified and Gram stain of the drainage revealed Gram-variable rods. A urinary source of C. perfringens was clinically supported. Although it is not a common presentation, nongastrointestinal sources such as a urinary source should be considered in C. perfringens bacteremia because failure to recognize a nongastrointestinal source can delay appropriate treatment, which may include surgical intervention.
authors.affiliation: Department of Medicine, University of Virginia, P.O. Box 800466, Charlottesville, VA 22908, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Millard
authors.affiliation: Division of Infectious Diseases and International Health, University of Virginia, P.O. Box 801379, Charlottesville, VA 22908, USA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: McManus
authors.affiliation: Division of Infectious Diseases and International Health, University of Virginia, P.O. Box 801379, Charlottesville, VA 22908, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Wispelwey