Hemólisis masiva intravascular y sepsis: Clostridium perfringens, un patógeno a tener en cuenta

We describe the case of a 68-year-old diabetic type 2 and hypercholesterolemic woman admitted to our hospital with a clinical frame consistent with acute cholecystitis. During the first hours of admission, an emergency cholecystectomy was performed without incidents, after which she begins with a hemodynamic deterioration, renal and clinical failure compatible with intravascular hemolysis and coagulopathy, of fatal evolution. The patient died 48 h after admission, despite the fact that empirical broad-spectrum antibiotic treatment and the support measures applied were started. Gram-positive bacilli were detected in blood cultures sensitive to the treatment established. Massive hemolysis is a condition caused by Clostridium perfringens, which can be associated with shock and multiple organ failure, as happened in this case. Although it is infrequent, a high index of suspicion and a rapid therapeutic action is very important, since it has a mortality of 70-100%.