First report of a fatal case of Clostridium porci bacteremia in an 8-month-old girl presenting with purpura fulminans associated with concurrent Yersinia pseudotuberculosis infection.

Abstract

Yersinia pseudotuberculosis rarely causes bacteremia, and Clostridium porci, an obligate anaerobic bacterium identified as part of the intestinal microbiota in pigs, has not been reported to cause human infection. We report an infant with VACTERL association who developed purpura fulminans due to concurrent infection with Y. pseudotuberculosis and C. porci. Upon transfer to our hospital, the patient went into shock. Laboratory findings revealed elevated inflammatory markers (white blood cell count of 25.3 × 10⁹/L and serum C-reactive protein level of 4.02 mg/dL), coagulopathy suggestive of disseminated intravascular coagulation (prothrombin time-international normalized ratio of 1.38 and plasma D-dimer level of 7.4 µg/dL), and decreased plasma protein C activity (28%). Gram-positive and Gram-negative bacilli were isolated from blood samples and identified as C. porci and Y. pseudotuberculosis using the bacterial 16S rRNA gene sequencing, respectively. Despite the intensive care, the patient died 55 h after admission. Since Y. pseudotuberculosis can cause bacteremia, the bacteria should be cultured under conditions that allow Y. pseudotuberculosis to grow when patients with gastrointestinal diseases go into shock. In addition, a detailed analysis of C. porci, including its pathogenicity, is necessary because it can cause severe infections.