Successful Nonsurgical Management of Clostridium perfringens Sepsis With Massive Intravascular Hemolysis and Liver Abscess: A Case Report.

Abstract

Background: Clostridium perfringens is an anaerobic, Gram-positive, spore-forming bacterium, commonly associated with gas gangrene and clostridial myonecrosis. Although bacteremia is rare, it carries a high mortality rate, particularly when complicated by massive intravascular hemolysis. Case Presentation: We report the case of a woman with poorly controlled diabetes mellitus who presented with fever, abdominal pain, systemic inflammatory response syndrome, respiratory insufficiency, and hemolytic anemia. Imaging studies revealed a hepatic abscess with gas formation, and blood cultures confirmed C. perfringens sepsis. Due to the patient's critical status, surgical intervention was deferred, and a multidisciplinary team initiated treatment involving intensive care, hematology, microbiology, immunohemotherapy, and surgery. Management and Outcome: Treatment included high-dose beta-lactam antibiotics combined with clindamycin, chosen for its antitoxin properties, alongside percutaneous drainage of the liver abscess and comprehensive intensive care support, including renal replacement therapy. The patient demonstrated progressive clinical improvement, with resolution of hyperlactatemia, successful weaning from vasopressors, and extubation. She completed a 28-day course of antibiotics and was discharged after a 75-day hospital stay. Conclusion: This case highlights the vital importance of early clinical suspicion, prompt diagnosis, and coordinated multidisciplinary management in C. perfringens sepsis. In the absence of well-established, evidence-based treatment protocols for this fulminant infection, our report illustrates a successful nonsurgical approach combining timely antimicrobial therapy, percutaneous source control through interventional radiology, and intensive organ support. Further research is essential to better define optimal management strategies and improve outcomes in this life-threatening condition.