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May 14, 1982

Clostridium perfringens Empyema Unresponsive to Penicillin

Author Affiliations

From the Department of Medicine, Emory University School of Medicine (Drs Silpa, Bulloch, Silverman, and Kenny), and Piedmont Hospital (Drs Silverman and Kenny), Atlanta. Dr Silpa is currently at Highland General Hospital, Oakland, Calif.

JAMA. 1982;247(18):2568. doi:10.1001/jama.1982.03320430072037

EMPYEMA caused by Clostridium perfringens is a rare infection that usually can be cured by penicillin therapy and drainage.1,2 We describe a patient with clostridial empyema that was unusual because the organism was unresponsive to penicillin therapy.

Report of a Case  A 49-year-old man with severe peripheral arterial disease of the legs was admitted because of heart failure due to alcoholrelated congestive cardiomyopathy. Pulses were not palpable in his right leg, and a 2×3-cm ulcer was present on his right foot. Initial chest roentgenogram showed cardiomegaly and pulmonary edema. Although his condition improved on digoxin, furosemide, and hydralazine hydrochloride, he experienced a temperature of 37.7 °C and mild mental confusion. His WBC count was 22,000/cu mm, with a differential cell count of 90% polymorphonuclear leukocytes and 2% band cells. Lumbar puncture studies gave normal results. A chest roentgenogram on the seventh hospital day showed a loculated right pleural effusion.