Clostridium perfringens liver abscess complicated by bacteremia

Abstract

A 63-year-old man had previously undergone resection for stage III colon cancer. Liver metastasis had resolved with palliative chemotherapy. The patient was now admitted because of weight loss, obstructive jaundice, and intrahepatic and extrahepatic biliary dilatation due to extrinsic compression of the biliary tree at the porta hepatis. Endoscopic retrograde cholangiography (ERCP) was performed with placement of a fully covered metal stent in the common bile duct and right hepatic duct, and the patient was discharged with downward-trending bilirubin levels. However, 10 days later, he was readmitted with dyspnea, abdominal pain, and a temperature of 100.1°F. Physical examination revealed chest pain at the left lower ribs and epigastric tenderness. Laboratory test results were white blood cell count 21.3 × 10 9 /L, bilirubin 7.6 mg/dL, alkaline phosphatase 212 U/L, and blood cultures positive for Clostridium perfringens (• " Fig. 1). Computed tomography of the abdomen showed a 3.1-cm collection of fluid that contained gas in the left lobe of the liver (• " Fig. 2). Inadequate drainage of the left hepatic system due to blockage by the stent in the right hepatic duct may have created a nidus for infection. The patient was successfully treated with intravenous antibiotics, abscess drainage, and removal of the metal stent (• " Fig. 3). C. perfringens is a rapidly growing (doubling time of 7 minutes), spore-forming, anaerobic, Gram-positive bacillus that is often found in the human bowel but rarely causes liver abscess and sepsis. To the best of our knowledge, approximately 22 cases of C. perfringens liver abscess resulting in septicemia have been reported, many of which were fatal [1]. The infections that lead to septicemia after ERCP are most commonly caused by Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae, but rarely C. perfringens [1]. C. perfringens infection has a mortality rate of 70 % to 100 %, often develops in immunosuppressed patients, and presents with fever, abscess, or hemolysis [2]. Liver abscess due to C. perfringens is a rare and often fatal event; a high degree of suspicion for the diagnosis and immediate treatment with drainage and antibiotics are required.

An Unusual Fatal Outcome of Laparoscopic Cholecystectomy: A Case Report

“…It is capable of producing heat-resistant spores and five types of toxins, particularly α-toxin, which damages the structural integrity of the cell, leading to tissue necrosis, gas gangrene, spherocytosis of red blood cells, and hemolysis. The isolation of the bacteria in fluid and blood cultures takes approximately 24 to 48 hours and may not be useful because culture-based antibiotic therapy delays treatment [ 5 - 7 ].…”

Clostridium perfringens Liver Abscess Disguised as Biliary Disease: A Report of Two Cases and a Review of the Literature

“… 1 , 2 This bacterium grows rapidly, showing a doubling time of approximately 7 min, and can tolerate up to 3% oxygen. 3 Its virulence mainly depends on the production of more than 20 types of potent toxins, including α-toxin, β-toxin, and Clostridium perfringens enterotoxin (CPE). High levels of these toxins in the blood circulation result in the rapid deterioration of the condition of affected patients, including progression to organ and circulatory failure, and even death.…”