INTRODUCTION
Clostridium sordellii, first identified in 1922 by Alfredo
Sordelli, is a beta hemolytic anaerobic gram-positive spore forming rod1,2. It is typically found in soil and the gut of many
animals, including humans 1. When found pathologically
in humans, C. sordellii is almost exclusively reported with
infections of the uterus and perineum; however, there have been rare
cases of infection in other locations of the body reported
post-operatively 1,3 or with intravenous drug use4,5. In most of the cases of Clostridialbacteremia, patients were predisposed to infection because of their
compromised immune system or underlying malignancy 6.
Suppressed immune system in many has also been a cause of delayed
presentation of signs of infection thus making the organism invariably
fatal.
Unfortunately, C. sordelli is highly virulent, causing death in
nearly 70% of cases 1,7. Its virulence is achieved
with exotoxins, primarily the lethal and hemorrhagic toxins1. Infection with C. sordelli typically causes
an acute onset leukemoid reaction accompanied by hypotension and
tachycardia. Some reports have demonstrated this pathogen to cause a
capillary leak syndrome, leading to hemoconcentration1. Even more severely, there have been reports ofC. sordelli , almost exclusively involving the uterus or perineum,
causing toxic shock syndrome 3,8.
Little guidance exists regarding the treatment of C. sordelli;although, some studies suggest that the infection is responsive to
beta-lactams, clindamycin, tetracycline, and chloramphenicol9.
This report presents a recent case that highlights the diagnosis and
treatment of Clostridium sordellii causing toxic shock syndrome
in the setting of a hemorrhagic necrotic renal mass and its
fistulization with the adjacent splenic flexure of the colon. This is
the first report of its kind.