Survival from Clostridium toxic shock syndrome: Case report and review of the literature.
Int J Surg Case Rep 2018;
50:64-67. [PMID:
30081323 PMCID:
PMC6083381 DOI:
10.1016/j.ijscr.2018.07.020]
[Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 11/30/2022] Open
Abstract
This case is a rare presentation of C. sordellii toxic shock syndrome resulting from a Caesarian section.
This is the only obstetric case of C. sordellii to have survived.
Extreme levels of a leukocytosis and hypotension without fevers raises suspiscion for this severe infection.
Broad spectrum antibiotics, including coverage for anaerobic organisms, and surgical intervention is the standard of care.
At the moment, no early detection or antitoxins are commercially available.
Introduction
Clostridial toxic shock is a rare syndrome traditionally described in case studies and reviews as a uniformly fatal condition associated with post-partum and post-abortion. Clostridium sordellii was first mentioned in scientific literature as a human pathogen in 1922 when Argentinian microbiologist Alfredo Sordellii identified the organism in gangrenous wounds. Over the past century, there has been infrequent discussion and little awareness surrounding this serious condition. Information about patients who survived C. sordellii toxic shock is essentially nonexistent.
Presentation of case
A 31-year old post-partum female who underwent caesarian section 17 days prior, presented with abdominal pain and septic features. She underwent six operations/procedures over the next 17 days and was hospitalized for 25 days before discharge to her home with a successful outcome.
Discussion
This case provides insight on the process of identifying and managing complications associated with clostridial toxic shock syndrome. Out of now, 16 reported cases of C sordellii gynecologic infections in the world literature, our patient is the second patient to survive infection by this organism. More research is needed to provide clinicians with evidence-based approaches for managing these unique cases.
Conclusion
We present a case report of a rare toxic shock syndrome in a post-partum female caused by Clostridium sordellii. Her survival is notable among 16 patients with whom this infection now has a documented 87.5% mortality rate. Aggressive surgical measures and optimized intensive care management may have contributed to this patient’s survival.
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