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May 14, 1982

Clostridium perfringens Empyema Unresponsive to Penicillin

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.