Clostridium perfringens (CP) is an anaerobic, Gram-positive bacillus associated with malignant diseases and near-term pregnancies. The necrotic tissue that results from these disease processes fuels the proliferation of CP, leading to gas gangrene and subsequently sepsis. Herein, we report a case of a 41-year-old female patient with a history of invasive molar pregnancy that was further complicated with a CP infection. Although past research has shown a link between Clostridium infection and choriocarcinoma (Chern-Horng and Hsieh, 1999), no previous cases of CP infection have been associated with invasive molar pregnancy. We also report complete resolution of the CP sepsis and its associated symptoms following the hysterectomy. 1. Introduction Clostridium perfringens (CP), an anaerobic Gram-positive bacillus, is found among the normal human intestinal and vaginal flora in approximately 25% of healthy women [1]. Clostridium infections are commonly associated with malignant diseases [2, 3]. Along with malignancies, it is often associated with caesarean sections and incomplete pregnancies. Injured and necrotic tissue in the uterus after delivery permit bacterial incubation and overgrowth of bacterial colonies [4]. Occasionally, CP can progress to gas gangrene, a form of tissue death, and may eventually lead to sepsis [1]. 2. Case Presentation A 41-year-old woman with a two-month history of gestational trophoblastic disease was admitted to Howard University Hospital on October 28, 2012, complaining of severe abdominal pain with fever as well as vaginal bleeding with clots. Her vaginal bleeding occurred intermittently since her diagnosis of invasive molar pregnancy on August 1, 2012. Additionally, she experienced bilateral leg pain for which she was started prophylactically on 40？mg of enoxaparin (Lovenox) subcutaneously at the time of admission. However, sonography ruled out deep vein thrombosis of both of her legs. She had already received 2 cycles of IV EMACO chemotherapy (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) by the time of presentation. At the time of her initiation of chemotherapy, her beta HCG (human chorionic gonadotropin) was 55,000？mlU/mL. Prior to this, she underwent a caesarean section with dilatation and curettage for her molar pregnancy at another institution on July 13, 2012. She was offered hysterectomy, which at the time she declined. At Howard University Hospital, she was diagnosed with anemia, recurrent carcinoma, sepsis, and hypertension. On physical examination, her temperature was normal, but she
References
[1]
R. Kurashina, H. Shimada, T. Matsushima, D. Doi, H. Asakura, and T. Takeshita, “Spontaneous uterine perforation due to clostridial gas gangrene associated with endometrial carcinoma,” Journal of Nippon Medical School, vol. 77, no. 3, pp. 166–169, 2010.
[2]
L. Chern-Horng and S.-Y. Hsieh, “Case report: clostridium septicum infection presenting as liver abscess in a case of choriocarcinoma with liver metastasis,” Journal of Gastroenterology and Hepatology, vol. 14, no. 12, pp. 1227–1229, 1999.
[3]
C. M. Larson, M. P. Bubrick, D. M. Jacobs et al., “Malignancy, mortality, and medicosurgical management of Clostridium septicum infection,” Surgery, vol. 118, no. 4, pp. 592–598, 1995.
[4]
J. T. Browne, A. H. Van Derhor, T. S. McConnell, and J. W. Wiggins, “Clostridium perfringens myometritis complicating cesarean section. Report of 2 cases,” Obstetrics and Gynecology, vol. 28, no. 1, pp. 64–69, 1966.
[5]
K. Hayashi, M. B. Bracken, D. H. Freeman Jr., and K. Hellenbrand, “Hydatidiform mole in the United States (1970–1977): a statistical and theoretical analysis,” American Journal of Epidemiology, vol. 115, no. 1, pp. 67–77, 1982.
[6]
K. D. Bagshawe, J. Dent, and J. Webb, “Hydatidiform mole in England and Wales 1973–83,” The Lancet, vol. 2, no. 8508, pp. 673–677, 1986.
[7]
J. R. Lurain, J. I. Brewer, E. E. Torok, and B. Halpern, “Natural history of hydatidiform mole after primary evacuation,” American Journal of Obstetrics and Gynecology, vol. 145, no. 5, pp. 591–595, 1983.
[8]
M. L. Bretzke, M. P. Bubrick, and C. R. Hitchcock, “Diffuse spreading Clostridium septicum infection, malignant disease and immune suppression,” Surgery Gynecology and Obstetrics, vol. 166, no. 3, pp. 197–199, 1988.
[9]
G. P. Bodey, S. Rodriguez, V. Fainstein, and L. S. Elting, “Clostridial bacteremia in cancer patients: a 12-year experience,” Cancer, vol. 67, no. 7, pp. 1928–1942, 1991.
[10]
M. E. Kolbeinsson, W. D. Holder Jr., and S. Aziz, “Recognition, management, and prevention of Clostridium septicum abscess in immunosuppressed patients,” Archives of Surgery, vol. 126, no. 5, pp. 642–645, 1991.
[11]
M. C. Thel, D. Ciaccia, J. J. Vredenburgh, W. Peters, and G. R. Corey, “Clostridium septicum abscess in hepatic metastases: successful medical management,” Bone Marrow Transplantation, vol. 13, no. 4, pp. 495–496, 1994.
[12]
J. L. Tully, M. A. Lew, M. Connor, and C. J. D'Orsi, “Clostridial sepsis following hepatic arterial infusion chemotherapy,” American Journal of Medicine, vol. 67, no. 4, pp. 707–710, 1979.
