Uterine Sarcoma Presenting with Sepsis from Clostridium perfringens Endometritis in a Postmenopausal Woman

Abstract

Clostridium perfringens is an anaerobic gram positive rod that is found in normal vaginal and cervical flora in 1–10% of healthy women. Uterine infection with Clostridium perfringens is seen rarely but is often related to underlying uterine pathology and can progress quickly to sepsis. Early recognition of sepsis, prompt treatment with antibiotics, and source control with surgical management allow for optimal chance of recovery. We present a case of a postmenopausal woman who presented with sepsis, vaginal bleeding, and back pain who was found to have Clostridium perfringens infection in the setting of undifferentiated uterine sarcoma.

Clostridium perfringens Bacteraemia following Normal Vaginal Delivery

“…In some instances, Clostridium bacteraemia may serve as the revealing event of underlying diseases, as reported by a Spanish group in a fatal case where postmortem analysis unveiled an undiagnosed colorectal neoplasm [ 9 ]. Coincidental diagnoses of gynaecologic malignancies, including undifferentiated uterine sarcoma and uterine endometrial adenocarcinoma, have also been reported [ 10 ]. Importantly, our patient showed no evidence of any gastrointestinal disorders.…”

Uterine leiomyosarcoma presenting as septic shock in a 43-year-old woman: A case report

“…Only two cases of uterine sarcoma that led to sepsis or septic shock have been reported [5,6]. The cause in both cases was an intrauterine endometrial infection caused by an ascending Clostridium perfringens infection, and the diagnosis after hysterectomy was undifferentiated uterine sarcoma in the advanced stage.…”

“…They cause systemic inflammatory response syndrome (SIRS), which could eventually lead to multiple organ dysfunction syndrome [4]. Although sepsis or septic shock has been reported to be present in patients with uterine sarcoma [5,6], there has been hitherto no reported case, to our knowledge, in which septic shock was the initial manifestation of uterine sarcoma. The present patient did not show uterine bleeding but abruptly showed septic shock.…”

Clostridium Perfringens Bacteremia with Acute Hemolytic Anemia in the Setting of Endometrial Malignancy

“…Though we recognize the risk of these infections in the peripartum period, one must also consider the ability for Clostridium species to flourish in the setting of degenerating malignancy. To date, there are only a few case reports of C perfringens infections associated with benign (2 –4) and malignant uterine abnormalities (5). While the literature of acute hemolytic anemia due to Clostridium is established, the relationship to endometrial malignancy is still quite sparse.…”