{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T13:44:20Z","timestamp":1782135860165,"version":"3.54.5"},"reference-count":12,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,6,15]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>A 22-year-old woman presented to the emergency room with right lower abdominal pain. A CT scan suggested potential appendicitis and perforation. She had no relevant medical or surgical history, and she last had vaginal sex 4 years prior to admission. During surgery, turbid fluid, secondary inflammatory changes, and dilated, fluid-filled fallopian tubes pointed to a diagnosis of pelvic inflammatory disease (PID), so she was started on azithromycin, metronidazole and piperacillin\/tazobactam. The following day, she continued to have abdominal pain and developed tachycardia, hypotension, a marked leukemoid response, haemoconcentration, third space fluid accumulation and acidosis. Culture results led to her being further diagnosed with <jats:italic>Clostridium perfringens<\/jats:italic> PID with peritonitis and toxic shock syndrome. A gynaecological infection of <jats:italic>C. perfringens<\/jats:italic> leading to toxic shock syndrome is both extremely rare and highly fatal. Her antibiotics were changed to meropenem and clindamycin, and she slowly made a full recovery.<\/jats:p>","DOI":"10.1136\/bcr-2021-242492","type":"journal-article","created":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T11:25:31Z","timestamp":1627385131000},"page":"e242492","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["<i>Clostridium perfringens<\/i> of unclear origin causing pelvic inflammatory disease and toxic shock syndrome in a previously healthy young woman"],"prefix":"10.1136","volume":"14","author":[{"given":"Brianna Danielle","family":"Covin","sequence":"first","affiliation":[{"name":"Department of Medical Education, Texas A&M University System Health Science Center College of Medicine, Bryan, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hector","family":"Chapa","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Texas A&M University System Health Science Center College of Medicine, Bryan, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nastassia","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Texas A&M University System Health Science Center College of Medicine, Bryan, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,7,27]]},"reference":[{"key":"2025082622400851000_14.7.e242492.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2008.06.018"},{"key":"2025082622400851000_14.7.e242492.2","doi-asserted-by":"publisher","DOI":"10.1007\/s11908-011-0207-7"},{"key":"2025082622400851000_14.7.e242492.3","first-page":"37","article-title":"Anaerobic bacteria as cause of infections in female genital organs","volume":"85","author":"Bergan","year":"1983","journal-title":"Scand J Gastroenterol Suppl"},{"key":"2025082622400851000_14.7.e242492.4","first-page":"357","article-title":"Pelvic inflammatory disease: diagnosis, management, and prevention","volume":"100","author":"Curry","year":"2019","journal-title":"Am Fam Physician"},{"key":"2025082622400851000_14.7.e242492.5","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/S0899-5885(02)00031-X","article-title":"Pelvic inflammatory disease and sepsis","volume":"15","author":"Dulin","year":"2003","journal-title":"Crit Care Nurs Clin North Am"},{"key":"2025082622400851000_14.7.e242492.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(11)90790-X"},{"key":"2025082622400851000_14.7.e242492.7","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-007-0194-6"},{"key":"2025082622400851000_14.7.e242492.8","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1067\/j.cpsurg.2011.12.002","article-title":"Unexpected gynecologic findings during abdominal surgery","volume":"49","author":"Boyd","year":"2012","journal-title":"Curr Probl Surg"},{"key":"2025082622400851000_14.7.e242492.9","first-page":"207","article-title":"Clostridium perfringens sepsis with massive intravascular haemolysis: a rare presentation","volume":"3","author":"Paulino","year":"2012","journal-title":"J Med Case Rep"},{"key":"2025082622400851000_14.7.e242492.10","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.resmic.2014.09.004","article-title":"Clostridium perfringens type A-E toxin plasmids","volume":"166","author":"Freedman","year":"2015","journal-title":"Res Microbiol"},{"key":"2025082622400851000_14.7.e242492.11","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.ajog.2009.05.023","article-title":"Undiagnosed cases of fatal Clostridium-associated toxic shock in Californian women of childbearing age","volume":"201","author":"Ho","year":"2009","journal-title":"Am J Obstet Gynecol"},{"key":"2025082622400851000_14.7.e242492.12","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001239"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-242492","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T05:40:14Z","timestamp":1756273214000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-242492"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7]]},"references-count":12,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7,27]]},"published-print":{"date-parts":[[2021,7]]}},"alternative-id":["10.1136\/bcr-2021-242492"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-242492","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7]]}}}