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A 68-year-old man presented with a one-month history of fever. He was bedridden due to Parkinson's disease, and a central venous catheter was inserted in his left femoral vein for parenteral nutrition at another hospital two months previously. Computed tomography revealed air in the subarachnoid space (Fig. 1A,B), in the vertebral canal (Fig. 1C), and in the left femoral vein (Fig. 1D). Three sets of blood cultures grew Clostridium perfringens. The catheter was removed and ampicillin was intravenously administered. Cerebrospinal fluid (CSF) obtained on day 4 showed leukocytosis (440/μL, polymorphonuclear; 89%) and a protein level of 311 mg/dL. Although the CSF culture did not grow bacteria, probably due to prior antibiotic administration, we believe that the pneumocephalus and pneumorrhachis were caused by C. perfringens meningitis. He recovered with ampicillin treatment.
Central nervous system infections by C. perfringens are rare (