Kristopaitis T, Jensen R, Gujrati M
Department of Pathology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Surg Neurol. 1999 Apr;51(4):448-50; discussion 450-1. doi: 10.1016/s0090-3019(97)00454-0.
Clostridium perfringens is a rare cause of central nervous system infections, particularly meningitis. The case of a 76-year-old man who developed fatal C. perfringens meningitis after routine decompressive laminectomy for spinal stenosis is described.
Twelve days after surgery the patient presented with pain and serosangiunous drainage from the surgical incision site. A swab of the drainage revealed Gram-positive bacilli; MRI of the lumbosacral spine showed the appearance of air around the laminectomy site. The patient died within 6 hours of presentation. Autopsy revealed acute cranial and spinal meningitis and choroid plexitis with organisms consistent with C. perfringens.
No significant enteral pathology or source of endogenous infection was determined, suggesting postoperative wound contamination and meningeal seeding with this ubiquitous organism. Clostridial infection, although rare, should be considered in any patient with meningitis with a history of surgical intervention. Survival with minimal neurological deficits was achieved in half of the previously reported cases.
