title: Non-lethal Clostridium sordellii bacteraemia in an immunocompromised patient with pleomorphic sarcoma.
abstract: Clostridium sordellii is a spore-forming anaerobic Gram-positive rod that has rarely been reported to cause disease in humans. Resultant mortality from infection is estimated at nearly 70% and is most often correlated with gynaecological procedures, intravenous drug abuse or trauma. C. sordellii infection often presents similarly to toxic shock syndrome (TSS); notable features of infection include refractory hypotension, haemoconcentration and marked leucocytosis. Although clinically similar to TSS, a notable difference is C. sordellii infections rarely involve fever. The organism's major toxins include haemorrhagic (TcsH) and lethal factor (TcsL), which function to disrupt cytoskeletal integrity. Current literature suggests treating C. sordelli infection with a broad-spectrum penicillin, metronidazole and clindamycin. We present a case of C. sordellii bacteraemia and septic shock in an immunocompromised patient who was recently diagnosed with pleomorphic gluteal sarcoma. Despite presenting in critical condition, the patient improved after aggressive hemodynamic resuscitation, source control and intravenous antibiotic therapy.
authors.affiliation: Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Alex K
authors.initials: AK
authors.lastname: Bonnecaze
authors.affiliation: Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Sarah Ellen Elza
authors.initials: SE
authors.lastname: Stephens
authors.affiliation: Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA Department of Anesthesia, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Peter John
authors.initials: PJ
authors.lastname: Miller
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D003015:Clostridium Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D047989:Paraclostridium sordellii; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008080:Liposarcoma / Q000382:microbiology*; D012772:Shock, Septic
chemical_list: D000900:Anti-Bacterial Agents