Infectious Diseases in Obstetrics and Gynecology 4:31-35 (1996)
(C) 1996 Wiley-Liss, Inc.
Clostridium sordellii Toxic Shock Syndrome"
A Case Report and Review of the Literature
Randy C. Sosolik, Beverley A. Savage, and Luis Vaccarello
Departments of Pathology (R.C.S.) and Obstetrics and Gynecology (B.A.S., L.V.), Ohio State University
Medical Center, Columbus, OH
ABSTRACT
Background: Since the 1980s, there have been isolated reports of a toxic shock syndrome associated
with Clostridium sordellii necrotizing subcutaneous infections during the puerperium. Relatively
localized fascial and muscle necrosis is noted at the surgical incision sites. However, circulating
toxins produce marked edema, resulting in shock and cardiovascular collapse. Despite aggressive
surgical and supportive therapy, all postpartum cases thus far have been fatal.
Case: A 24-year-old primipara developed an episiotomy infection which progressed to involve
the underlying fascia and muscle. Despite early and adequate debridement of the devitalized tissue,
she developed anasarca, marked leukocytosis, refractory hypotension, hypothermia, and a persistent
coagulopathy, and expired on postpartum day 5. The cultures from the excised tissue grew C.
sordellii. All blood cultures were negative.
Conclusion: Treatment modalities aimed solely at the eradication of the microbe and removal of
necrotic tissue, although essential components of therapy, have proved inadequate. Future efforts
should be directed toward neutralization or elimination of the circulating exotoxins responsible for
the systemic shock.
(C) 1996 Wiley-Liss, Inc.
KEY WORDS
Anasarca, lethal toxin, myonecrosis, anaerobe
lostridium sorde//ii is an anaerobic inhabitant of
he soil and gastrointestinal tract. Since its dis-
covery in 1922,1 this species has been occasionally
implicated (usually with other histotoxic pathogens)
as a cause of gas gangrene. Recently, however, there
have been reports of a distinct "toxic shock-like"
entity attributed to soft-tissue infections with C.
sordellii alon