Fatal Toxic Shock Syndrome Resulting from <i>Clostridium sordellii</i> Bacteremia after Perforation of a Low Rectal Cancer

<b><i>Background:</i></b> <i>Clostridium sordellii</i> infections are rare and highly lethal. They are most associated with medical abortions and other genitourinary procedures. We report a fatal case of <i>C. sordellii</i> bacteremia from a perforated low rectal cancer with rectovaginal fistula. <b><i>Case Presentation:</i></b> A 60-year-old female presented with 10 days of abdominal pain, loose stools, and hematochezia. She developed rapidly progressive septic shock. Imaging identified a perforated rectal mass, pneumovagina, and a large pelvic abscess. She underwent fecal diversion and drainage of the pelvic abscess. Despite this intervention, she had refractory septic shock with multisystem organ failure resulting in death. Blood cultures grew <i>C. sordellii</i> post-mortem. <b><i>Conclusion:</i></b> <i>C. sordellii</i> infections are often fatal if not treated immediately. Clinicians must have a high index of suspicion in rectal cancer with associated gynecological involvement.