Clostridium sordelliiToxic Shock Syndrome: A Case Report and Review of the Literature

[摘要] Background:Since the 1980s, there have been isolated reports of a toxic shock syndrome associatedwithClostridium sordelliinecrotizing subcutaneous infections during the puerperium. Relativelylocalized fascial and muscle necrosis is noted at the surgical incision sites. However, circulatingtoxins produce marked edema, resulting in shock and cardiovascular collapse. Despite aggressivesurgical and supportive therapy, all postpartum cases thus far have been fatal.Case:A 24-year-old primipara developed an episiotomy infection which progressed to involvethe underlying fascia and muscle. Despite early and adequate debridement of the devitalized tissue,she developed anasarca, marked leukocytosis, refractory hypotension, hypothermia, and a persistentcoagulopathy, and expired on postpartum day 5. The cultures from the excised tissue grewC. sordelliiAll blood cultures were negative.Conclusion:Treatment modalities aimed solely at the eradication of the microbe and removal ofnecrotic tissue, although essential components of therapy, have proved inadequate. Future effortsshould be directed toward neutralization or elimination of the circulating exotoxins responsible forthe systemic shock.

[学科分类] 妇产科学