A fatal postpartum Clostridium sordellii associated toxic shock syndrome.

Abstract

Clostridium sordellii is an infrequent human pathogen. It has been demonstrated to be occasionally responsible for myonecrosis or gas gangrene. Interestingly, in the obstetric literature, some cases of postpartum maternal deaths have been associated with C sordellii infection causing a rapidly lethal toxin mediated syndrome. This is the first reported case of postpartum death in a 29 year old woman, in which a toxigenic C sordellii was isolated from the patient's blood antemortem during the fatal toxic shock, strongly indicating its role in this rare syndrome. (7 Clin Pathol 1997;50:259-260) Keywords: Clostridium sordellii; shock; toxin; postpartum. Case report A caesarean section was performed in a 29 year old woman, gravida 1, for cervical dystocia in the 41st week. The postoperative course was normal. Two days after delivery the patient was afebrile but complained of generalised weakness, dizziness in an orthostatic position, and pain in the epigastric region followed by hypotension (80/50 mm Hg), sinus tachycardia (1IO beats/minute), and low urinary output. The patient was given fluids and steroids but hypotension proved refractory. The abdomen was painful and tender. Ultrasonogram showed hyperperistalsis and anechoic areas scattered in the abdominal cavity; blood analysis showed noticeable haemoconcentration and hyperproteinemia. Laparotomy revealed a substantial amount of serosanguineous fluid, the peritoneum was lifted by a jelly-like retroperitoneal tissue, the appendiceal apex was hyperaemic and adhered to the rear parietal peritoneum, and the right adnexa appeared oedematous and thickened. Gall bladder, duodenum, stomach, ileum, ascendens, and transverse colon appeared thickened and ischaemic. Pancreas, spleen, and liver were normal. The patient underwent appendectomy and removal of the right adnexa, and was treated with antibiotics (intravenous cefotaxime 1 g three times a day.). Peritoneal exudate and blood were collected and cultured. Although clinical conditions partially improved, after a few hours the hypotension became refractory, her skin was pale and cool with cyanotic extremities, her temperature was normal, haematocrit was 57.6%, haemoglobin was 246 g/l, white cell count was 115 x 109/1; a decrease in total protein concentration (26 g/l), and calcium concentration (64 mg/l) was also observed. Because of serious cardiac conditions the patient was moved to an intensive care unit where she died six hours later. Clinical Pathology Microbiological studiesBlood was collected during laparotomy while the patient was on antibiotic therapy. Bactec 26A and Bactec 27A broths (Becton Dickinson Italia, Milan) were used to grow aerobes and anaerobes, respectively, in an automatic Bactec NR 730. Subcultures were performed using Schaedler agar (Difco Laboratories, Detroit, Michigan) supplemented with vitamin K for anaerobes, and mannitol salt agar, desoxycholate agar, Colombia blood agar and Sabouraud agar (Difco) for aerobes and yeasts. The peritoneal fluid was inoculated into thioglycollate and ...

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