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Hitoshi Honda, Simi Padival, Brian Heist, Tetsuya Hoshi, Pervasive Pneumatosis in a Patient on Immunosuppressive Agents, Clinical Infectious Diseases, Volume 53, Issue 7, 1 October 2011, Pages 744–745, https://doi.org/10.1093/cid/cir517
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Extract
(See page 696 for the Photo Quiz.)
Diagnosis: Clostridium perfringens Bacteremia
Culture of the serosanguinous fluid sampled from a bulla revealed C. perfringens, and blood culture subsequently grew C. perfringens and Klebsiella pneumoniae. Hemolysis was not confirmed by peripheral blood smear in this case. The patient died within 60 minutes after the initial presentation. Postmortem computed tomography (CT) revealed air throughout the entire body, including the cranium, chest, abdomen, and subcutaneous tissues (Figures 1 and 2).
Clostridium perfringens is an anaerobic, Gram-positive, spore-forming bacillus, and bacteremia due to this organism has reemerged as an important clinical infection. C. perfringens is the most commonly identified among Clostridium species involved in bloodstream infections, and although rare, the diagnosis is increasing [1, 2]. This is presumably due to factors including advances in anaerobic blood culture techniques and a growing population of elderly patients and complicated patients with comorbid illness [1, 3].
Clostridium bacteremia may develop in immunocompetent hosts after trauma or surgery, but more commonly it occurs in immunocompromised hosts, including those with old age (≥65 years), malignancy, requirement of hemodialysis, Crohn’s disease, cirrhosis, or diabetes mellitus [1, 2, 4, 5]. Another predisposing factor is the use of chemotherapeutic agents, given the damage that they inflict on mucosal barriers [3]. Regarding the portal of C. perfringens entry into the bloodstream, preexisting soft-tissue infection and myonecrosis are well-known sites, but multiple portals have been identified, including the lungs and the hepatobiliary, gastrointestinal, genitourinary, and reproductive tracts [1, 5–9]. Concurrent polymicrobial bacteremia, especially with Enterobacteriaceae, may be observed, depending on the portal of entry [5, 8, 10].
