J Pediatr Infect Dis 2014; 09(01): 031-035
DOI: 10.3233/JPI-140410
Case Report
Georg Thieme Verlag KG Stuttgart – New York

Systemic Clostridium toxicity resulting from a knee laceration in a child

Alyssa Fesmire
University of Tennessee College of Medicine, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, USA
,
Jeffrey Sawyer
Department of Orthopedic Surgery – Campbell Clinic, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, USA
,
William C. Warner Jr.
Department of Orthopedic Surgery – Campbell Clinic, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, USA
,
Steven Buckingham
Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, USA
,
Bindiya Bagga
Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, USA
,
Kanwaljeet J.S. Anand
Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, USA
,
Derek M. Kelly
Department of Orthopedic Surgery – Campbell Clinic, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, USA
› Author Affiliations

Subject Editor:
Further Information

Publication History

30 July 2013

11 April 2014

Publication Date:
28 July 2015 (online)

Abstract

This report describes the clinical course and treatment of a C. perfringens infection in a child following an injury to the knee that resulted in sepsis and multi-organ system failure. Diagnosis of the causative agent and systemic nature of the infection was delayed because of the non-traditional presentation, in which the patient appeared to have a localized necrotizing fasciitis and did not display symptoms consistent with severe systemic involvement. He was treated with vancomycin, wound debridement and fasciotomy. After identification of C. perfringens, vancomycin therapy was discontinued in favor of penicillin and clindamycin. With intensive supportive care, the patient recovered fully and resumed regular activities within two months. These infections are rare in children, but they can be life threatening. It is important to include systemic Clostridium infection in a differential so it can be recognized early and appropriate treatment begun as soon as possible.