Pita Zapata E, Sarmiento Penide A, Bautista Guillén A, González Cabano M, Agulla Budiño J A, Camba Rodríguez M A
Servicio de Anestesiología y Reanimación, Hospital Arquitecto Marcide, Area Sanitaria de Ferrol, A Coruña.
Rev Esp Anestesiol Reanim. 2010 May;57(5):314-6. doi: 10.1016/s0034-9356(10)70234-6.
Massive hemolysis secondary to sepsis caused by Clostridium perfringens is a rare entity but appears fairly often in the literature. In nearly all published reports, the clinical course is rapid and fatal. We describe the case of a 75-year-old woman with diabetes who was admitted with symptoms consistent with acute cholecystitis. Deteriorating hemodynamics and laboratory findings were consistent with intravascular hemolysis, coagulation disorder, and renal failure. Gram-positive bacilli of the Clostridium species were detected in blood along with worsening indicators of hemolysis. In spite of antibiotic and surgical treatment, hemodynamic support and infusion of blood products, the patient continued to decline and died in the postoperative recovery unit 14 hours after admission. Mortality ranges from 70% to 100% in sepsis due to Clostridium perfringens, and risk of death is greater if massive hemolysis is present, as in the case we report. Only a high degree of clinical suspicion leading to early diagnosis and treatment can improve the prognosis. This bacterium should therefore be considered whenever severe sepsis and hemolysis coincide.
由产气荚膜梭菌引起的败血症继发的大量溶血是一种罕见的情况，但在文献中相当常见。在几乎所有已发表的报告中，临床病程迅速且致命。我们描述了一名75岁糖尿病女性的病例，她因与急性胆囊炎相符的症状入院。血流动力学恶化和实验室检查结果与血管内溶血、凝血障碍和肾衰竭一致。血液中检测到产气荚膜梭菌属的革兰氏阳性杆菌，同时溶血指标不断恶化。尽管进行了抗生素和手术治疗、血流动力学支持以及输注血液制品，但患者仍持续病情恶化，入院后14小时在术后恢复病房死亡。产气荚膜梭菌败血症的死亡率在70%至100%之间，如我们报告的病例那样，如果存在大量溶血，死亡风险更高。只有高度的临床怀疑才能导致早期诊断和治疗，从而改善预后。因此，每当严重败血症和溶血同时出现时，都应考虑这种细菌。
