Fatal Clostridium perfringens septicemia suggested by postmortem computed tomography: A medico-legal autopsy case report

• Clostridium (Cl.) perfringens septicemia is one of the most lethal infections.
• The fulminant course with no specific symptoms complicates the diagnosis.
• The excessive gas accumulation was observed in the postmortem computed tomography.
• It suggested a gas-forming infection, and was helpful for postmortem diagnosis.

We report a fatal case of suspected Clostridium (Cl.) perfringens septicemia in a previously healthy woman in her eighties. At first, she presented at the hospital complaining of upper abdominal discomfort and vomiting, and was discharged the next day after ruling out any fatal conditions. However, her condition deteriorated approximately 10 h after discharge and she died shortly after.The postmortem computed tomography (PMCT) performed 29 h postmortem revealed an excessive systemic gas accumulation compared with the postmortem external appearance and time elapsed since her death, which suggested the presence of a gas-forming infection. Histopathological examination showed diffuse proliferation of Gram-positive bacilli in almost all the organ tissues, especially in blood vessels. Along with these findings, hyperthermia 3 h postmortem, and severe anemia and thrombocytopenia without an obvious site of hemorrhage suggested hemolysis due to Cl. perfringens septicemia. These findings suggested the diagnosis before performing the conventional autopsy. To the best of our knowledge, this is the first case report to describe PMCT findings of gas-forming infection and septicemia in contrast with the external appearance and histopathological findings in a medico-legal autopsy setting.