DISCUSSION
This report describes a patient with back pain and uncontrollable
shaking, ultimately diagnosed with a C. sordelli infection and
successfully treated with a course of antibiotics. The majority ofC. sordelli cases reported infect patients during childbirth or
gynecologic procedures 1; however, the patient
described in this case presented in the setting of a hemorrhagic
necrotic renal mass and its fistulization with the adjacent splenic
flexure of the colon. It is suspected that the gastrointestinal tract
was the source of this patient’s Clostridial infection that
likely reached the bloodstream post colonic fistulization with the
necrotic, hemorrhagic renal mass.
The pathogenicity of C. sordellii has been mainly attributed to
its hemorrhagic and lethal toxins that are known to cause local
necrosis and edema 1. These toxins share immunological
cross reactivity with C. difficile toxin A and B, being a part of
the large family of Clostridial glucosylating toxins. These
toxins work at the cellular level using similar molecular mechanisms
involving glucosylation of Rho and/or Ras GTPAses. When infected,
patients may first notice nonspecific symptoms that quickly evolve into
massive tissue edema, effusions from the capillary leak, profound
leukocytosis, hemoconcentration, refractory hypotension, and
tachycardia. Typically, on initial presentation patients infectedwith C. sordelli are already experiencing symptoms of toxic
shock, as this patient did, due to its rapidly progressive nature1,10. A recent article reported that leukemoid
reactions, defined as a WBC count >50,000/ml, were highly
suggestive of fatality. This article described 45 cases, which had a
mortality rate of 69%. Of these patients, 80% had a leukemoid
reaction, and the majority died within 2-6 days of infection1.
As this patient’s history does not follow the typical presentation, this
report emphasizes the importance of recognizing the signs and symptoms
of this infection and acting quickly due to its high mortality rate.C. sordelli must be considered in patients who present in septic
shock following a recent surgery or procedure, given the fact that there
is no rapid diagnostic test for this infection 1. This
creates a barrier to rapid diagnosis, which can cause a delay in
treatment. Upon suspicion of this diagnosis, empiric antibiotic therapy
should be started while awaiting blood cultures. While little
information exists to support a standard treatment regimen, studies
suggest C. sordelli is susceptible to beta-lactams, clindamycin,
tetracycline, and chloramphenicol, and resistant to aminoglycosides and
sulfonamides 9. Although further investigation is
warranted, use of anti-clostridial toxins as a form of treatment has
been suggested 1,3, and may help guide treatment in
such patients.