Species involved: Clostridium perfringens, Cl. septicum, others
Clinical features:
(1) high fever
(2) hypotension and shock
(3) hemolysis with hemoglobinemia
(4) tachycardia
Clues:
(1) evidence of ischemic bowel
(2) presence of an intra-abdominal or pelvic tumor
(3) gas-producing infection, clinically or on imaging studies
(4) positive blood cultures for a Clostridium species (underlying the need to perform blood cultures on patients with unexplained fever)
Differential diagnosis:
(1) immune-mediated hemolytic transfusion reaction (the workup should show compatible units with a negative DAT)
(2) drug-induced hemolytic anemia, especially beta-lactam antibiotic related
(3) bacterial contamination of a blood product (which underlies the need to Gram stain and culture a blood product implicated in a possible transfusion reaction)
