Clostridium perfringens gangrenous cystitis with septic shock and bone marrow necrosis

摘要

Laboratory tests on a healthy 34-year-old woman who complained of bone pain revealed thrombopenia with a platelets level of 94 x 10~9/L (154-395 x 10~9/L) and decreased leukocytes [4 x 10~9/L (3.8-9.5 x 10~9)] and procalcitonin (PCT, <0.05 ng/mL). She was admitted to the internal medicine ward with a suspected diagnosis of inflammatory arthropathy and pred-nisone (1 mg/kg/day per os) was attempted with no biological follow-up. Seven days later, she presented with an isolated fever and pancyto-penia. Bone marrow (BM) examination revealed only rare lytic cells and occasional large bacilli. Blood cultures were positive for Clostridium perfringens. Later that day, she was admitted to the ICU for septic shock, jaundice, and spontaneous hematuria. Laboratory tests revealed hemolytic anemia with low reticulocytes and disseminated intra- vascular coagulation (Table 1).