Multi-Organ Failure Secondary to a Clostridium Perfringens Gaseous Liver Abscess following a Self-Limited Episode of Acute Gastroenteritis

Abstract

Patient: Female, 81Final Diagnosis: Liver abscesSymptoms: Diarrhea • jaundice • vomiting • weaknessMedication: —Clinical Procedure: CT scan guided drainageSpecialty: Gastroenterology and HepatologyObjective:Rare diseaseBackground:Clostridium perfringens is an unusual pathogen responsible for the development of a gas-forming pyogenic liver abscess. Progression to septicemia with this infection has amplified case fatality rates.Case Report:We report a case of an 81-year-old lady with pyogenic liver abscess with gas formation that was preceded by an acute gastroenteritis. The most common precipitating factors are invasive procedures and immunosuppression. Clostridium perfringens was unexpectedly isolated in the drained abscess, as well as blood. It is a normal inhabitant of the human bowel and a common cause of food poisoning, notoriously leading to tissue necrosis and gas gangrene.Conclusions:We report a case of gas-forming pyogenic liver abscess and bacteremia progressing to fatal septic shock, caused by an uncommon Clostridium perfringens isolate.

The Evolving Nature of Hepatic Abscess: A Review

“… 19 There are several pathophysiologic features of DM that contribute to higher infection risk. 18 , 20 For instance, hyperglycemia is known to alter neutrophil metabolism. 21 Diabetics also have been shown to have impaired polymorphonuclear leukocyte (PMN) chemotaxis and phagocytosis, 18 , 20 which weakens their immune defense against infections and leaves them more susceptible to abscess formation.…”

“…Other conditions and treatments may compromise the immune system and render it inadequate to counteract pathogens. These include various immunodeficiencies, chemotherapy, solid malignancies, immunosuppression therapy after organ transplant, 20 as well as splenectomy, 23 all of which have been associated with an increased risk of HA.…”

“… 32 Under these circumstances, bacteria gain access to the portal venous system and then to the liver bed. 8 , 20 In some of these cases, the HA was the presenting sign 30 and has been considered to be a herald of silent colon cancer. 5 …”

“… 19 , 21 , 34 Clostridium perfringens has also been reported in the literature more frequently, but it is still a rare cause of HA. 20 Depending on the primary source of infection, multiple organisms can be involved in HA. 9 Eltawansy et al reported the presence of mixed organisms in 14%–55% of cases.…”

Septic Shock with Multi Organ Failure Due to Fluoroquinolones Resistant Campylobacter Jejuni

“…In the Pigrau et al case series, only 1 out of 47 bacteremia cases were due Campylobacter jejuni developed septic shock [ 5 ]. Even if case fatality rate due to Campylobacter jejuni bacteremia is low, around 10% (but may be higher in HIV infected patients) [ 1 ], blood stream infections associated with high Pittsburgh Bacteremia Score can cause death [ 6 , 7 ]. In a recent retrospective study the mortality attributable to septic shock caused by Campylobacter jejuni was high (4 out of 4 cases died) [ 1 ].…”