Abstract
A 73-year-old woman was admitted to our hospital because of genital bleeding, high fever and severe hypotension. Urine samples were bloody, and urinalysis revealed occult blood. Hemolysis was suspected, because her total bilirubin (T-Bil), AST and LDH levels rose to 7.6 mg/dl, 77 IU/l and 589 IU/l, respectively. When we examined the patient, there was purulent discharge flowing out from the vagina. The Gram stain of the discharge revealed a large number of Gram-positive rods. Abdominal CT showed a large quantity of gas in the uterus. We made the diagnosis of septic shock associated with uterine gas gangrene caused by Clostridium species. We immediately started treatment for the shock, and hysterectomy was performed for source control. We treated the patient intensively with multidisciplinary approaches, including administration of vasopressin and hydrocortisone, as well as mechanical ventilation and renal replacement therapy. Her T-Bil, AST and LDH were elevated to 30.9 mg/dl, 2,751 IU/l and 5,898 IU/l, respectively, by intravascular hemolysis on hospital day 3. In spite of massive intravascular hemolysis, the patient gradually improved and was discharged from the ICU. A final culture of blood and secretion of the uterus revealed C. perfringens. Massive intravascular hemolysis is a classic complication of C. perfringens septicemia and usually fatal. Early recognition and intensive therapy are needed to save patients' lives.
