Title : A case report of clostridium perfringens sepsis and haemolytic anaemia in endometrial cancer
Abstract:
Background: Clostridium perfringens is a gram-positive, anaerobic, spore-forming bacillus. C. perfringens infections can cause acute and often fatal haemolytic anaemia, mediated by release of the alpha toxin.
Aims: C.perfringens endometritis is more commonly seen in the obstetric setting. This case report from New Zealand highlights one such instance of fulminant infection in a patient with endometrial malignancy.
Methods: Written consent for presentation of this case was obtained from the patient's next-of-kin.
Results: A 72 year old woman awoke with severe abdominal pain and fever and presented to the emergency department. Her past medical history included metastatic high-grade endometrial adenocarcinoma (2 previous cycles of carboplatin and paclitaxel), saddle pulmonary embolus (diagnosed a month prior and putting further chemotherapy on hold), previous Guillain-Barre syndrome, previous Coxsackie B infection, asthma, cholecystectomy and appendicectomy (latter two were historical). Just 2 days prior to this, a CT scan had shown peritoneal progression of her cancer.
On arrival to ED the patient was tachypneic, tachycardic and hypoxic. She was started on IV antibiotics (gentamicin and metronidazole). Her serial blood tests repeatedly haemolysed. Just 6 hours later, her haemoglobin had dropped from 89 g/L to 59 g/L (despite red blood cell transfusion) and her platelets had dropped from 349 × 109/L to 229 × 109/L. An urgent CT revealed spicules of gas extending out the right fallopian tube, concerning for endometritis with a gas-forming organism.
Due to poor functional status, her ceiling of care was ward-based. Treatment with antibiotics and blood transfusions was ceased later that evening due to clinical deterioration and she passed away the next morning. Her blood cultures subsequently grew Clostridium Perfringens.
Conclusion: This case highlights the poor prognosis of haemolytic anaemia secondary to infection from C. perfringens, and underscores the need for early recognition and aggressive treatment in septic patients with endometrial malignancy.
