Clostridium perfringens bacteremia secondary to tubo-ovarian abscess in a post-menopausal, immunocompetent female: a case report

BACKGROUND: Clostridium perfringens is an anaerobic gram-positive rod that colonizes the gastrointestinal and female genital tracts. It is an uncommon cause of bacteremia but is associated with high mortality when present. The most commonly reported sources include intraabdominal infections, soft tissue necrosis, and malignancy-related processes. Most affected patients are elderly or immunocompromised. CASE PRESENTATION: We present a case of C. perfringens bacteremia in a 52-year-old postmenopausal female with no history of malignancy, recent surgery, or immunosuppression. The patient presented to the emergency department with generalized abdominal pain, hypotension, and leukocytosis. Imaging showed pneumoperitoneum, which was suggestive of a perforated viscus. She underwent emergency laparoscopy, which revealed a ruptured right-sided tubo-ovarian abscess (TOA) involving the cornua of the uterus. Gynecology was consulted, and the ruptured TOA and fallopian tube were removed. Blood and intraoperative pelvic fluid cultures both grew C. perfringens. The patient completed a 10-day course of antibiotics and was discharged in stable condition. CONCLUSIONS: This case shows an unusual source of C. perfringens bacteremia in a patient without the typical risk factors. It also highlights the need to keep TOA on the differential diagnosis in postmenopausal women presenting with abdominal pain and sepsis, even in the absence of prior gynecologic disease. Early source control and appropriate antimicrobial coverage were critical in this patient’s recovery.