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.