History and clinical findings: A 37-year-old chronic alcoholic had increasingly frequent haematemesis and recently had developed upper abdominal pain. His general condition had clearly deteriorated and he was finally admitted as an emergency. There were no previous illnesses other than alcoholism. He had a fever of 39.0 degrees C on admission, his sclerae were icteric and his abdomen was hard and resistant to palpation. He was slightly drowsy.
Investigations: Laboratory tests indicated haemolysis with a haemoglobin of 10 g/dl, lactate dehydrogenase concentration of 330 U/l, urobilinogenuria and a raised white blood cell count of 11,500/microliter. Sonography revealed liver cirrhosis and ascites.
Treatment and course: Because of the haematemesis a gastroscopy was performed, during which the patient went into acute shock from which he died. At autopsy the cause of the bleeding was found to be an ulcer at the oesophagocardiac junction. The gastrointestinal tract was filled with blood. He also had alcoholic liver cirrhosis with portal hypertension, as well as splenomegaly as sign of a septicaemia. Histologically masses of rod-shaped bacteria were found, especially in the heart, but also in liver, kidneys and peritoneum, which bacteriologically were identified as Clostridium sordellii.
Conclusion: In patients with impaired immunological resistance Clostridium sordellii may cause an acute and quickly fatal septicaemia with intravascular haemolysis.