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.