Necrotising pneumonia and empyema caused by Clostridium bifermentnas.

A 41-year-old woman was admitted to the hospital with a one-week history of increasing fatigue, weakness, 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 fibrillation, and the blood pressure was 110/66 mmHg. Examination did not reveal conjunctival petechiae, mucous membrane lesions, ulcerations, splinter haemorrhages, 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' (neutrophils 70% and the SGOT and LDH were both raised. Chest radiograph demonstrated generalised cardiomegaly, prominent vasculature to the upper