title: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Emergency and Acute Intensive Care Medicine, Aichi Medical University, Nagakute, Japan.
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Hashiba
authors.affiliation: Department of Emergency and Acute Intensive Care Medicine, Aichi Medical University, Nagakute, Japan.
authors.forename: Atsutoshi
authors.initials: A
authors.lastname: Tomino
authors.affiliation: Department of Emergency and Acute Intensive Care Medicine, Aichi Medical University, Nagakute, Japan.
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Takenaka
authors.affiliation: Department of Emergency, Nagoya City University, Nagoya, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Hattori
authors.affiliation: Department of Emergency and Acute Intensive Care Medicine, Fujita Health University, Toyoake, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kano
authors.affiliation: Department of Emergency and Acute Intensive Care Medicine, Aichi Medical University, Nagakute, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Tsuda
authors.affiliation: Department of Emergency and Acute Intensive Care Medicine, Aichi Medical University, Nagakute, Japan.
authors.forename: Naoshi
authors.initials: N
authors.lastname: Takeyama
mesh_terms: D000369:Aged, 80 and over; D000743:Anemia, Hemolytic / Q000382:microbiology*; D003015:Clostridium Infections / Q000150:complications* / Q000175:diagnosis; D003016:Clostridium perfringens; D017809:Fatal Outcome; D005334:Fever / Q000382:microbiology*; D006801:Humans; D008100:Liver Abscess / Q000382:microbiology; D008297:Male; D012772:Shock, Septic / Q000382:microbiology