Complication of Invasive Molar Pregnancy with Clostridium perfringens Sepsis

Clostridium perfringens (CP) is an anaerobic, Gram-positive bacillus associated with malignant diseases and near-term pregnancies. The necrotic tissue that results from these disease processes fuels the proliferation of CP, leading to gas gangrene and subsequently sepsis. Herein, we report a case of a 41-year-old female patient with a history of invasive molar pregnancy that was further complicated with a CP infection. Although past research has shown a link between Clostridium infection and choriocarcinoma (Chern-Horng and Hsieh, 1999), no previous cases of CP infection have been associated with invasive molar pregnancy. We also report complete resolution of the CP sepsis and its associated symptoms following the hysterectomy. 1. Introduction Clostridium perfringens (CP), an anaerobic Gram-positive bacillus, is found among the normal human intestinal and vaginal flora in approximately 25% of healthy women [1]. Clostridium infections are commonly associated with malignant diseases [2, 3]. Along with malignancies, it is often associated with caesarean sections and incomplete pregnancies. Injured and necrotic tissue in the uterus after delivery permit bacterial incubation and overgrowth of bacterial colonies [4]. Occasionally, CP can progress to gas gangrene, a form of tissue death, and may eventually lead to sepsis [1]. 2. Case Presentation A 41-year-old woman with a two-month history of gestational trophoblastic disease was admitted to Howard University Hospital on October 28, 2012, complaining of severe abdominal pain with fever as well as vaginal bleeding with clots. Her vaginal bleeding occurred intermittently since her diagnosis of invasive molar pregnancy on August 1, 2012. Additionally, she experienced bilateral leg pain for which she was started prophylactically on 40？mg of enoxaparin (Lovenox) subcutaneously at the time of admission. However, sonography ruled out deep vein thrombosis of both of her legs. She had already received 2 cycles of IV EMACO chemotherapy (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) by the time of presentation. At the time of her initiation of chemotherapy, her beta HCG (human chorionic gonadotropin) was 55,000？mlU/mL. Prior to this, she underwent a caesarean section with dilatation and curettage for her molar pregnancy at another institution on July 13, 2012. She was offered hysterectomy, which at the time she declined. At Howard University Hospital, she was diagnosed with anemia, recurrent carcinoma, sepsis, and hypertension. On physical examination, her temperature was normal, but she