Gas-Forming Pyogenic Liver Abscess with Septic Shock

Abstract

The pyogenic liver abscess caused by Clostridium perfringens (C. perfringens) is a rare but rapidly fatal infection. The main virulence factor of this pathogen is its α-toxin (lecithinase), which decomposes the phospholipid in cell membranes leading to cell lysis. Once the bacteria are in blood stream, massive intravascular hemolysis occurs. This can present as anemia on admission with evidence of hemolysis as indicated by low serum haptoglobin, high serum lactate dehydrogenase (LDH), elevated indirect bilirubin, and spherocytosis. The clinical course of C. perfringens septicemia is marked by rapidly deteriorating course with a mortality rate ranging from 70 to 100%. The very rapid clinical course makes it difficult to diagnose on time, and most cases are diagnosed at autopsy. Therefore it is important to consider C. perfringens infection in any severely ill patient with fever and evidence of hemolysis. We present a case of seventy-seven-year-old male with septic shock secondary to pyogenic liver abscess with a brief review of existing literature on C. perfringens.

Microwave ablation of liver metastasis complicated by Clostridium perfringens gas-forming pyogenic liver abscess (GPLA) in a patient with past gastrectomy

“…C. perfringens can cause infections such as liver abscess, lung abscess and soft tissue infection. If left untreated, it could escalate rapidly into septicaemia, resulting in life-threatening situation and, ultimately, death in 70% −100% of patients [3] . Risk factors for such deterioration include diabetes mellitus, liver cirrhosis or immunocompromised state.…”

Effects of dopamine, norepinephrine and dobutamine on gastric mucosal pH of septic shock patients

“…In the present investigation, of 48 cases with septic shock, the gastric mucosal pH was monitored when patients were treated either with dopamine or norepinephrine alone or with norepinephrine and dobutamine in combination to observe the effects of vasoactive drugs on gastric pH ( 6 ).…”

Ruptured Emphysematous Liver Abscess: An Unusual Presentation in Kochs

“…Mortality rate ranging from (27–30%) warrants prompt diagnosis and urgent intervention. It is caused by Klebsiella pneumonia in 80% of cases; however E. coli, Salmonella typhi [ 5 ] and Clostridium perfrigens [ 6 ] are also accused of the same. The virulence factors of K. pneumoniae are reported to be rmp A (regulator of mucoid phenotype gene A), mag A (mucoid-associated gene A), capsular serotype, lipopolysaccharide, hypermucoviscosity phenotype.…”