Korean J Hematol.  2007 Dec;42(4):409-413. 10.5045/kjh.2007.42.4.409.

A Case of Massive Intravascular Hemolysis Associated with Clostiridium perfringens Sepsis

• Park KS
• Kang SY
• Lee WI

• KMID: 2252228
• DOI: http://doi.org/10.5045/kjh.2007.42.4.409

Abstract

Clostridium perfringens is an anaerobic, gram-positive rod that inhabits the soil and the intestinal tracts of many animals, including humans. C. perfringens is a major cause of food poisoning, traumatic or nontraumatic myonecrosis, clostridial cellulitis, gangrenous cholecystitis, sepsis or bacteremia, and intravascular hemolysis. Massive intravascular hemolysis is a rare complication of C. perfringens septicemia and has a high mortality rate with an extremely rapid progression. Therefore, aggressive treatment is required as soon as the diagnosis is made. In this study, we report a case of massive intravascular hemolysis due to C. perfringens septicemia in a 34-year-old man with liver cirrhosis.

Keyword

Clostiridium perfringens; Massive intravascular hemolysis; Sepsis

MeSH Terms

Adult
Animals
Bacteremia
Cellulitis
Cholecystitis
Clostridium perfringens
Diagnosis
Foodborne Diseases
Hemolysis*
Humans
Liver Cirrhosis
Mortality
Sepsis*
Soil
Soil

Figure

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  Fig. 1 WBC, RBC, and PLT histograms (Coulter LH750, Beckman Coulter, Inc, CA, USA) showed unusual patterns. Especially most of RBC were small sized. Mean corpuscular volume was 53.9fL (A, B, and C). WBC scattergram showed bad separation of the population; the segmented neutrophil population (pink area) was mixed with monocyte population (green area), and lymphocyte population (blue area). The manual count of white blood cells revealed 63% segmented neutrophils, 25% lymphocytes, and 12% monocytes (D).

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  Fig. 2 The peripheral blood smear showed gross intravascular hemolysis with reddish background, a lot of irregular sized erythrocytes, many spherocytes, ghost erythrocytes, and toxic change in neutrophils with toxic vacuoles [(A) Wright-Giemsa stain, ×200; (B) Wright-Giemsa stain, ×1,000].

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  Fig. 3 Simple abdomen supine x-ray showed extensive subcutaneous emphysema on left side buttock and left inguinal area (A). Abdomen CT showed possible extensive gas gangrene and muscle destruction in the left buttock and left inguinal area (B).

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  Fig. 4 Gram stain showed gram positive bacilli (×1,000).

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  Fig. 5 Blood agar plate showed double zone of beta he-

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