A 70-year-old woman with a history of successfully resected pancreatic cancer 10 years ago presented with dyspnea and fever. Laboratory tests showed leukocytosis (white cell count 20.8 × 10⁹/L) and elevated C-reactive protein (87 mg/L) with normal hemoglobin concentration (Hb) (137 g/L) and platelet count (242 × 10⁹/L). Computed tomography identified a hepatic abscess. The abscess was drained and ceftriaxone-metronidazole was administered intravenously. Sixteen hours after presentation, the patient's condition deteriorated, with Hb dropping to 50 g/L while the platelet count remained normal. Macroscopically the blood sample appeared dark (left image), and no red blood cells could be separated upon centrifugation. A blood film showed spherocytosis and dehemoglobinized ghost cells (right image, May–Grünwald–Giemsa ×100 objective), indicating acute intravascular hemolysis. Despite early drainage plus antibiotic treatment, and admission to the intensive care unit, the patient died 21 h after initial presentation. Blood and abscess cultures grew Clostridium perfringens (metronidazole susceptible).

C. perfringens liver abscess and subsequent sepsis with fulminant intravascular hemolysis are rare, but have been previously documented.¹ Alpha-toxin secretion induces spherocytosis and hemolysis by disrupting cell membrane integrity via phospholipase activity.² This case emphasizes that despite prompt diagnosis and treatment, this condition can be fatal within hours of initial presentation. A recent case report suggests that toxin-clearing interventions, following rapid diagnosis, may improve outcome in patients with acute hemolysis due to C. perfringens sepsis.³ Early treatment requires efficient communication between the laboratory and clinicians when blood samples raise the suspicion of intravascular hemolysis, followed by prompt blood film examination. Spherocytosis and the presence of ghost cells are important in suggesting this particular infection.

一名 70 岁女性，10 年前有胰腺癌成功切除史，出现呼吸困难和发热。实验室检查显示白细胞增多 （白细胞计数 20.8 × 10⁹/L） 和 C 反应蛋白升高 （87 mg/L），血红蛋白浓度 （Hb） （137 g/L） 和血小板计数 （242 × 10⁹/L） 正常。计算机断层扫描发现肝脓肿。引流脓肿，静脉内给予头孢曲松-甲硝唑。就诊 16 小时后，患者病情恶化，Hb 降至 50 g/L，而血小板计数保持正常。肉眼观察，血样呈深色（左图），离心时无法分离红细胞。血涂片显示球形红细胞增多和去血红蛋白化的鬼细胞（右图，May-Grünwald-Giemsa×100 物镜），提示急性血管内溶血。尽管早期引流加抗生素治疗并入住重症监护病房，但患者在初次就诊后 21 h 死亡。血液和脓肿培养物生长产气荚膜梭菌 （甲硝唑敏感）。

产气荚膜梭菌肝脓肿和随后的脓毒症伴暴发性血管内溶血很少见，但以前有记录。¹ α-毒素分泌通过磷脂酶活性破坏细胞膜完整性，从而诱导球形红细胞增多症和溶血。² 本病例强调，尽管及时诊断和治疗，但这种情况可能在初次就诊后数小时内致命。最近的一份病例报告表明，快速诊断后的毒素清除干预措施可能会改善产气荚膜梭菌败血症引起的急性溶血患者的预后。³ 早期治疗需要实验室和临床医生在血样怀疑血管内溶血时进行有效沟通，然后及时进行血涂片检查。球形红细胞增多和幽灵细胞的存在在提示这种特殊感染方面很重要。