Gas-forming liver abscess associated with rapid hemolysis in a diabetic patient

Abstract

We experienced a case of liver abscess due to Clostridium perfringens (CP ) complicated with massive hemolysis and rapid death in an adequately controlled type 2 diabetic patient. The patient died 6 h after his first visit to the hospital. CP was later detected in a blood culture. We searched for case reports of CP septicemia and found 124 cases. Fifty patients survived, and 74 died. Of the 30 patients with liver abscess, only 3 cases survived following treatment with emergency surgical drainage. For the early detection of CP infection, detection of Gram-positive rods in the blood or drainage fluid is important. Spherocytes and ghost cells indicate intravascular hemolysis. The prognosis is very poor once massive hemolysis occurs. The major causative organisms of gas-forming liver abscess in diabetic patients are Klebsiella pneumoniae (K. pneumoniae ) and Escherichia coli (E. coli ). Although CP is relatively rare, the survival rate is very poor compared with those of K. pneumoniae and E. coli . Therefore, for every case that presents with a gas-forming liver abscess, the possibility of CP should be considered, and immediate aspiration of the abscess and Gram staining are important.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Liver abscess; Gas-forming; Clostridium perfringens ; Hemolysis; Diabetes Core tip: Gas-forming liver abscess caused by Clostridium perfringens can result in massive hemolysis and death within several hours. For survival, urgent surgical intervention and antibiotic administration are necessary.Kurasawa M, Nishikido T, Koike J, Tominaga S, Tamemoto H. Gas-forming liver abscess associated with rapid hemolysis in a diabetic patient. World J Diabetes 2014; 5(2): 224-229 Available from:

Massive haemolysis, gas-forming liver abscess and sepsis due toClostridium perfringensbacteraemia

“…Since this disease is uncommon, but can be potentially life-threatening, our management probably prevented a rapid deterioration of the patient. We had no suspicion of a liver abscess, and the former therapy (ceftriaxone and levofloxacin) was empirical, but probably insufficient 5. We were only able to properly manage the infection when we noticed the gas-forming abscess.…”

“…Bacteraemia due to C. perfringens is uncommon, but often associated with a fatal outcome 1 4. Sepsis due to Clostridium infections is known to have a poor prognosis, often associated with shock and massive haemolysis 4 5. It is generally accepted that identifying the clinical features of C. perfringens infections is difficult.…”

Characteristics of gas-forming pyogenic liver abscess caused by Klebsiella pneumoniae and Clostridi perfringens

“…There were no statistically significant differences in gender between survivors and the deceased in patients with GFPLA-Cp. However, an earlier study found that significantly more female than male patients survived (P<0.05) [24]. The difference may be associated with basic patient conditions, such as the presence of underlying diseases, age, and nationality.…”

Gas-Forming Pyogenic Liver Abscess with Septic Shock

“…Another study from Japan reported that, among 5011 blood samples that were positive for any bacteria, only 41 were positive for Clostridium . Of the 41 samples, 16 were confirmed as septicemia, and 9 of the 16 were positive for C. perfringens [ 16 ]. The incidence of C. perfringens septicemia was reported to be 0.7 in 100000 per year in Canada [ 17 ].…”

“…The clinical course of C. perfringens septicemia and liver abscess is usually aggressive with high mortality ranging up to 70% to 100% [ 19 ]. The initial presentation can be variable, but fever and abdominal pain are common symptoms [ 16 ]. The abdominal pain has been strongly associated with a ruptured liver abscess.…”