Background: Clostridium perfringens is a rare but life-threatening cause of maternal sepsis, and can cause rapid development of uterine myonecrosis in the postpartum setting due to release of exotoxins. Early recognition is critical due to its high associated mortality.
Case: We report the case of a previously well 30-year-old primiparous woman who developed Clostridium perfringens uterine myonecrosis and bacteraemia following an emergency Caesarean section at 39 weeks and 5 days gestation for pre-eclampsia. Post-operatively she developed severe abdominal pain, rapidly evolving sepsis and extensive intraabdominal necrosis, necessitating a total hysterectomy and bilateral salphingectomy. Broad spectrum antibiotics were initiated and later rationalised to amoxicillin-clavulanate, after tissue and blood cultures grew Clostridium perfringens. The patient made a full recovery and was discharged on day 10 postpartum. Her infant, delivered weighing 2470g with APGARS of 9 and 9 at 1 and 5 minutes respectively, did not develop any infections in the neonatal period.
Conclusion: This case illustrates the fulminant course of C. perfringens infection in the postpartum period and the diagnostic difficulty posed by non-specific early signs. Severe pain, significantly elevated inflammatory markers and gas on imaging should prompt early surgical evaluation for necrotising soft tissue infection. Timely diagnosis, surgical source control and appropriate antimicrobial therapy were essential to this patient’s survival.