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Postmortem evaluation demonstrated reactive gliosis, atypical lymphocytic inflammation, mild hydrocephalus, hippocampal atrophy, vascular congestion, microthrombi, and oligodendrocyte loss, without hemorrhage. Next-generation sequencing confirmed Paeniclostridium sordellii infection despite negative cultures, after HLH and CNS lymphoma were microscopically excluded.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/chronic-basal-ganglia-infarction-with-pcr-identified-paeniclostridium-sordellii-a-rare-neuropathological-case-report/453745/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/chronic-basal-ganglia-infarction-with-pcr-identified-paeniclostridium-sordellii-a-rare-neuropathological-case-report/453745.png","ImageObject",300,407,{"name":42,"@type":43},"Aurelia","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-01","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What 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2026, Article ID 7304864, 5 pages [https://doi.org/10.1155/crip/7304864](https://doi.org/10.1155/crip/7304864)  \nCase Report  \nChronic Basal Ganglia Infarction With PCR-Identified Paeniclostridium sordellii: A Rare Neuropathological Case Report  \nCassandra Lamm , Angus Toland , and Samuel Guzman   \nDepartment of Pathology, University of Colorado, Anschutz Medical Center, Aurora, Colorado, USA  \nCorrespondence should be addressed to Cassandra Lamm; [cassandra.lamm@cuanschutz.edu](cassandra.lamm@cuanschutz.edu)  \nReceived 12 August 2025; Revised 28 November 2025; Accepted 16 December 2025  \nAcademic Editor: Amit Agrawal  \nCopyright © 2026 Cassandra Lamm et al. Case Reports in Pathology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \nBackground: Within 1 month of diagnosis, 40% of patients with positive blood cultures will develop CNS complications. Rare pathogens, that is, Paeniclostridium sordellii, pose diagnostic challenges due to atypical presentations and detection difficulties. Case Presentation: A 67-year-old man presented with metabolic encephalopathy and diabetes insipidus. Imaging showed bilateral basal ganglia abnormalities and an enhancing lesion near the anterior commissure, suspicious for neoplasm. Postmortem findings included reactive gliosis, atypical lymphocytic inflammation, and polyclonal plasma cells. NGS performed at the University of Washington confirmed P. sordellii infection.  \nNeuropathologic Findings: The gross and histologic examination showed mild hydrocephalus, right hippocampal atrophy, and anterior commissure–centric inflammation. Vascular congestion, arteriosclerosis with microthrombi, and oligodendrocyte loss were present without hemorrhage.  \nDifferential Diagnosis: Hemophagocytic lymphohistiocytosis and CNS lymphoma were considered but ruled out microscopically. Conclusion: This case highlights the importance of considering P. sordellii in CNS inflammatory lesions and demonstrates the utility of molecular diagnostics in negative cultures.  \n1. Introduction  \nPaeniclostridium sordellii is a rare but highly virulent, sporeforming, anaerobic, Gram-positive bacterium. It is found in rural soil, the gastrointestinal tracts of animals and humans, and rarely in vaginal flora [1, 2] . Infections are uncommon but potentially fatal, especially in postpartum or postabortive women, intravenous drug users, and trauma/surgical patients. Clinical presentation often includes afebrile shock with tachycardia, hypotension, leukemoid reaction, hemoconcentration, edema, and hemorrhage. P. sordellii produces a lethal toxin, TcsL, which disrupts endothelial integrity via the SEMA6A and SEMA6B receptors, causing rapid systemic decompensation [3]. In animals, P. sordellii has been implicated in enteric and histotoxic disease in horses, ruminants,  \nand birds, with pathology often demonstrating mucosal necrosis, hemorrhage, and systemic vascular injury [1] . Central nervous system inflammation and necrosis due to hemophagocytic lymphohistiocytosis (HLH) can pose a diagnostic challenge when a brain lesion contains a dense lymphohistiocytic infiltrate, especially in the absence of systemic findings [4], highlighting the need for a high index of suspicion anda broad differential when encountering unusual brain lesions.  \n2. Case Presentation  \nA 67-year-old man was found deceased at home following an eight-day hospitalization for acute metabolic encephalopathy and severe hypernatremia with a subsequent eight-day inpatient rehabilitation admission. Neurological deficits during  \n2 Case Reports in Pathology  \n(a) (b)  \nFigure 1: Gross photographs. (a) Right hippocampal atrophy and amygdala enlargement. (b) Anterior commissure lesion.  \nhis hospital stay included acute global debility, acute cognitive impairm","cbCaivlHrhCZRdM3","https://ap.wps.com/l/cbCaivlHrhCZRdM3","pdf",1853465,"English","# Background\n# Case Presentation\n# Neuropathologic Findings\n# Differential Diagnosis\n# Conclusion","[{\"question\":\"What clinical features were observed in the patient before death?\",\"answer\":\"The patient presented with metabolic encephalopathy and central diabetes insipidus, with hospital course complications including cognitive impairment, unsteady gait, and persistent blurry vision.\"},{\"question\":\"What did imaging suggest during hospitalization?\",\"answer\":\"Imaging first showed bilateral basal ganglia T2 signal abnormalities and later an enhancing lesion near the anterior commissure, which was suspicious for a neoplasm.\"},{\"question\":\"How was the pathogen identified despite negative cultures?\",\"answer\":\"Cultures of cerebrospinal fluid were negative, but next-generation sequencing performed at the University of Washington confirmed Paeniclostridium sordellii infection.\"}]","Chronic Basal Ganglia Infarction With PCR-Identified Paeniclostridium sordellii: A Rare Neuropathological Case Report | PDF",1790739478,13]