To investigate the diagnosis and treatment of Paeniclostridium sordellii (P. sordellii) infection in diabetes patients with toxic shock syndrome (TSS).

A patient with TSS as the primary clinical manifestation was detailed, and the blood culture was confirmed as P. sordellii by genomic alignment after being identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Toxic shock syndrome and coagulation disorder caused by P. sordellii were analyzed based on genomics analysis.

The patient had a 4-year history of diabetes and presented clinically with toxic shock syndrome with a significantly elevated total leukocyte count and neutrophil count. The anaerobic blood culture was reported positive for three days. The microorganism formed irregular colonies after temporary seeding in an anaerobic environment, and MALDI-TOF MS combined with 16S rDNA sequence detection confirmed the diagnosis of P. sordellii. Genomic analysis of P. sordellii contains hemolysin, phospholipase C and neuraminidase genes, and the products encoded by the genes can lead to inflammatory and hemolytic responses. The treatment was ineffective after the administration of comprehensive anti-infective symptomatic treatment, and the disease deteriorated rapidly and the patient died within half a month after diagnosis.

Rapid identification by MALDI-TOF MS and genomic analysis are essential for diagnosing and treating infection caused by P. sordellii. Rapid identification of P. sordellii infection by mass spectrometry after isolation and culture of anaerobic bacteria combined with bioinformatics analysis is critical to diagnosing and treating P. sordellii infection.