Toxic Shock Syndrome, Clostridium sordellii

Key Features

• C sordellii is a rare cause of endometritis and toxic shock syndrome following childbirth

• Fatal cases of uterine infection following medically induced abortion with mifepristone have been reported

Clinical Findings

• Abdominal pain

• Absence of fever

• Onset of illness was within 4–5 days of ingestion of mifepristone

• Clinical course is fulminant

• Infection appeared to be limited to the uterus, which shows

  • Necrosis

  • Edema

  • Hemorrhage

  • Acute inflammatory changes

Diagnosis

• Tachycardia, severe hypotension, capillary leak syndrome with edema

• Profound leukocytosis, hemoconcentration

Treatment

• Early recognition

• Aggressive resuscitation from shock

• Immediate surgical debridement with hysterectomy

• Administration of an antimicrobial active against C sordellii, including

  • Penicillin

  • Ampicillin

  • Macrolide

  • Clindamycin

  • Tetracycline

  • Metronidazole