Necrotising pneumonia and empyema caused by Clostridium bifermentans

The Clostridia are unusual causes of primary pleuro-pulmonary infection in the absence of penetrating chest injury or surgery. ' We describe here the first reported case of primary pleuropulmonary infection caused by Clostridium bifermentans, in this case associated with pulmonary thromboembolism. Case report A 41-year-old woman was admitted to the hospital with a one-week history of increasing fatigue, weak-ness, and breathlessness. She had a persistent cough, haemoptysis, and a sharp pleuritic chest pain on the right the evening before admission. Her temperature was 36-3'C (oral), the respiratory rate was 30/min, the pulse was 130/min with atrial fibril-lation, and the blood pressure was 110/66 mmHg. Examination did not reveal conjunctival petechiae, mucous membrane lesions, ulcerations, splinter haem-orrhages, or Janeway lesions. Murmurs consistent with mitral stenosis, mitral regurgitation, aortic stenosis, and aortic regurgitation were present. There wras no calf tenderness, Homans ' sign was absent, and neurological examination was within normal limits. The total leucocyte count was 15 800/mm ' (neu-trophils 70 % and the SGOT and LDH were both raised. Chest radiograph demonstrated generalised cardiomegaly, prominent vasculature to the upper Fig 1 Chest radiograph on the ninth hospital day showing discrete lucent areas within the right lower lobe and left upper lobe infiltrates