Emerging infectious diseases
A Clostridium sordellii fatal toxic shock syndrome post-medical-abortion in PortugalT. Reis, C. Chaves, A. Soares, M. Moreira, L. Boaventura*, G. Ribeiro (Coimbra, PT)
Background: Clostridum sordellii (C. sordellii) is a gram-positive anaerobic bacillus that has been reported as a rare cause of fatal toxic syndrome after medical abortion. Portugal’s legal therapeutic abortion, before 10 weeks of gestation, was approved in 2007. We report a case of a young patient who underwent a medical induced abortion and died of a C. sordellii toxic shock syndrome.
Case summary: A 16-year-old women who underwent a medically induced abortion by means of 200 mg of oral mifepristone followed by 800 µg of vaginal misoprostol, presented to the maternity hospital’s emergency five days after receiving mifepristone, complaining of lipothimia in the night before and abdominal cramping. On admission, she was conscient, afebrile and hypotense (76/35mmHg). A few hours later she developed a rapid onset-sepsis with marked leukocitosis (83,400 white-cells/µL with 88% of neutrophils), hemoconcentration (hematocrit of 63.4%; hemoglobin of 21.2) and severe metabolic acidosis. The patient underwent a hysterectomy and uterus biopsy cultures and anatomopathological analysis were requested. Patient was transferred to intensive care unit and died 18h after presenting to emergency. At the microbiology laboratory a direct examination by gram-stain smear of the uterine biopsy showed large, gram positive rods. The biopsy was inoculated in appropriated agar plates mediums and incubated aerobically and anaerobically. 48 h later only the anaerobic culture was positive and colonies were smeared by gram stain (showing gram positive rods) and a C. sordellii was identified by the semi-automated system, Vitek 2 (bioMerieux®) with an ANC card (Anaerobes and Corynebacterium card).
Discussion: This was a fatal case of pos-abortion C. sordellii sepsis. The distinctive clinical features developed are the same reported in other studies. Gram staining of a uterine biopsy is a good and rapid mean of having a presumptive result and help to diagnose. C.sordellii was identified through uterine biopsy cultures with a semi-automated system which is different from other studies that used anti-clostridium species immunochemical assay and PCR assays performed on formalin fixed uterine tissue pos-autopsy.
Conclusion: To improve diagnosis gram staining and cultures of an endometrial biopsy specimen are a good approach to an earlier recognition of the disease’s etiology.