title: Fulminant Clostridium perfringens Sepsis in Kidney Transplant: A Case Report.
abstract: BACKGROUND
  Infections, particularly urinary tract infections, and cardiovascular accidents are the main causes of morbidity and mortality during the 1st year after kidney transplantation (KT). Bacteria and viruses, such as Escherichia coli, Enteroccoci, and Polyoma BK virus are common in the 1st 6 months, so they are controlled routinely. On the other hand, Clostridium perfringens infection is a rare life-threatening condition, associated with a high mortality rate especially in the transplant population, that is not controlled routinely.
  
  
  METHODS
  A 50-year-old man with end-stage renal disease secondary to hypertension and focal segmental glomerulosclerosis underwent living-related KT. He recovered well and was discharged 11 days after KT. Two weeks after his discharge, he presented with severe abdominal pain, fever, and vomiting. Radiologic assessment showed pneumoperitoneum. Urgent exploratory laparotomy revealed significant amount of gas and no bowel perforation. However, right retroperitoneal gas collection was noted and drained. Blood culture was positive for C perfringens. Patient died after 48 hours, with signs of multiorgan failure.
  
  
  CONCLUSIONS
  Clostridium perfringens sepsis is severe and usually lethal in the transplant population. Prevention is difficult because the origin of the infection is unclear. Keeping high suspicion in patients with sudden and unexplained septic shock and aggressive surgical and medical treatment are fundamental.
authors.affiliation: Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: pmihaylo@iupui.edu.
authors.forename: P
authors.initials: P
authors.lastname: Mihaylov
authors.affiliation: Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: J A
authors.initials: JA
authors.lastname: Powelson
authors.affiliation: Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: W C
authors.initials: WC
authors.lastname: Goggins
mesh_terms: D015746:Abdominal Pain / Q000382:microbiology; D003016:Clostridium perfringens; D004322:Drainage / Q000009:adverse effects; D042241:Early Diagnosis; D017809:Fatal Outcome; D005738:Gas Gangrene / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000382:microbiology; D012187:Retroperitoneal Space; D018805:Sepsis / Q000175:diagnosis* / Q000382:microbiology; D012772:Shock, Septic / Q000209:etiology; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000382:microbiology