in most cases of clostridium sordellii infections occur after trauma , childbirth , and routine gynecological procedures or intravenous drug abuse . the organism first described in 1922 by sordellii who isolated the bacteria from a patient with postoperative gas gangrene . a 22 year old female presented in the emergency department with complaints of fatigue , malaise , dizziness , shortness of breath , and abdominal distension for the last 5 days . she had a full - term normal vaginal home delivery 10 days back and the baby expired 6 days after the birth . there was no history of fever , abdominal pain , or post partum hemorrhage . on examination pulse was 110/min , blood pressure was 80/60 mmhg . respiratory system revealed bilateral pleural effusion , evident by absent breath sounds , and stony dullness on the bilateral lower axillary area . cns and cvs were normal . on gynecological examination labia majora were edematous and vaginal mucosa was congested and friable . on bimanual examination , uterus was tender , bilateral fornices were nonpalpable and nontender . on laboratory examination hb 11.6 gm / dl , hematocrit 35% , and total leukocyte count of 64,030/m with polymorph 83% , lymphocyte 4% , and promyelocyte 13% , esr 58 mm , general blood picture was normocytic normochromic . crp was > 150 mg / l . renal and liver function test and blood sugar were normal . on ascitic fluid examinations , total cell count were 3200/mm with 60% rbc , 37% lymphocyte , and 3% polymorphs . on gram staining gram positive rods were present and culture was positive for clostridia ; differentiation of clostridium species could not be done due to unavailability of laboratory facility for different clostridia subspecies . ascitic fluid afb staining was negative , pleural fluid was exudative in nature and culture was sterile for gram staining and afb . patient was shifted in intensive care unit and administered fluid vasopressors , fresh frozen plasma , and intravenous antibiotic ( piperacillin / tazobactam , gentamicin , and clindamycin ) . in the world 's literatures from 1927 to 2006 only 45 cases of c. sordellii infection have been reported , 69% of patients usually died within 2 to 6 days of developing the infection . c. sordellii is confounded by early , nonspecific signs and symptoms and by the absence of fever . patients with a c. sordellii characteristically develop a profound systemic capillary leak , refractory hypotension , and a marked leukemoid reaction ( lr ) along with fatal tachycardia . c. sordellii have been isolated in vaginal secretions of 510% of a nonpregnant women . during labor or abortion open cervix permits the passage of vaginal pathogens that appears to be the critical event that leads to infection of the endometrium . infection occurs almost exclusively in association with infection of the uterus or the perineum after either infected episiotomy or postpartum endometritis . clinical presentation includes sudden onset influenza such as prodrome , progressive refractory hypotension , hypothermia , or absence of fever and absence of purulent discharge . distinctive pathological finding includes significant local edema with pleural and peritoneal effusion , localized tissue necrosis , and thrombosis of nearby vessels . c. sordellii is associated with a profound exotoxin - mediated systemic response characterized by anasarca , refractory hypotension , and marked leukocytosis . diagnosis of c. sordellii toxic shock syndrome ( tts ) should be suspected when previously healthy women with recent definitive diagnosis requires isolation of c. sordellii from infected tissue as blood culture is usually negative . have described 45 cases , 8 ( 18% ) were associated with normal childbirth , 5 ( 11% ) were associated with medically induced abortion , and 2 ( 0.4% ) were associated with spontaneous abortion . other cases of c. sordellii infection ( in 19 patients [ 43% ] ) occurred after trauma or surgery . eighty - five percent of all patients with fatal cases died within 26 days of initial infection , and nearly 80% of fatal cases developed lr . c. sordellii neuraminidase stimulates proliferation of promyelocytic hl-60 cells . it also modifies vascular cell adhesion molecule 1 , which orchestrates the release of mature and immature granulocytes from bone marrow stromal cells . thus , neuraminidase likely plays an important role in the characteristic lr in c. sordellii infection . rorbye , and bitti et al . have reported a case of postpartum death due to c. sordellii tts . new diagnostic approaches are needed to define the true burden of c. sordellii in gynecologic infections as they pose a difficult clinical challenge . improved treatments are needed to reduce the morbidity and mortality of these infections as these infections are usually fatal . strong suspicion should be made if peripartum female presents with toxic shock syndrome with refractory shock , edema , ascites , pleural effusion without fever or pain . early recognition of c. sordellii tss may be life saving as this infection has higher mortality and fatal out come with delayed treatment .
clostridium sordellii is gram positive anaerobic spore forming rod and it has been demonstrated to cause gas gangrene , refractory shock , leukemoid reaction , and pleuroperitoneal effusion due to capillary leak . 
 we report here a case of postpartum female who presented with leukemoid reaction , ascites , pleural effusion , and shock without fever 7 days after normal vaginal home delivery .