Korean J Gastroenterol.  2013 Feb;61(2):103-106. 10.4166/kjg.2013.61.2.103.

A Case of Clostridium Liver Abscess with Sepsis

• Lee SH
• Kim HS
• Kim SJ
• Shin WG
• Kim KH
• Jang MK
• Lee JH
• Kim HY

• KMID: 1775775
• DOI: http://doi.org/10.4166/kjg.2013.61.2.103

Abstract

Clostridial septicemia usually occurrs in patients with immunocompromised diseases such as diabetes and malignancy. Clostridial liver abscess is very rare but highly fatal. We experienced a case of Clostridial septicemia due to liver abscess in a 73-year-old man. He was presented with fever and chills. On admission, abdominal CT scan showed about 35 mm sized hypoattenuated lesion with multiple central air-bubbles. After the diagnosis of liver abscess, the patient underwent prompt empirical antimicrobial therapy and percutaneous drainage. In spite of early therapy, the patient had gone into shock and death.

Keyword

Clostridium; Liver abscess; Sepsis

MeSH Terms

Aged
Clostridium/*isolation & purification
Clostridium Infections/diagnosis/*microbiology
Drainage
Humans
Liver/radiography
Liver Abscess/complications/*diagnosis/microbiology
Male
Sepsis/complications/*diagnosis
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Abdominal computed tomography showed about 3.5 cm sized hypoattenuated lesion with multiple central air-bubbles in the right anterosuperior area (segment VIII) of the liver.

Reference

References

1. Bae IG, Cho YK, Hong SS, et al. A cases of liver abscess with sepsis caused by Clostridium perfringens. J Korean Soc Chemother. 1999; 17:239–244.

2. Moore-Gillon JC, Eykyn SJ, Phillips I. Microbiology of pyogenic liver abscess. Br Med J (Clin Res Ed). 1981; 283:819–821.

3. Brook I, Frazier EH. Microbiology of liver and spleen abscesses. J Med Microbiol. 1998; 47:1075–1080.

4. van Bunderen CC, Bomers MK, Wesdorp E, Peerbooms P, Veenstra J. Clostridium perfringens septicaemia with massive intravascular haemolysis: a case report and review of the literature. Neth J Med. 2010; 68:343–346.

5. Kivel RM, Kessler A, Cameron DJ. Liver abscess due to Clostridium perfringens. Ann Intern Med. 1958; 49:672–679.

6. Kahn SP, Lindenauer SM, Wojtalik RS, Hildreth D. Clostridia hepatic abscess. An unusual manifestation of metastatic colon carcinoma. Arch Surg. 1972; 104:209–212.

7. Mera CL, Freedman MH. Clostridium liver abscess and massive hemolysis. Unique demise in Fanconi's aplastic anemia. Clin Pediatr (Phila). 1984; 23:126–127.

8. Nachman S, Kaul A, Li KI, Slim MS, San Filippo JA, Van Horn K. Liver abscess caused by Clostridium bifermentans following blunt abdominal trauma. J Clin Microbiol. 1989; 27:1137–1138.

9. Thel MC, Ciaccia D, Vredenburgh JJ, Peters W, Corey GR. Clostridium septicum abscess in hepatic metastases: successful medical management. Bone Marrow Transplant. 1994; 13:495–496.

10. Lee CH, Hsieh SY. Case report: Clostridium septicum infection presenting as liver abscess in a case of choriocarcinoma with liver metastasis. J Gastroenterol Hepatol. 1999; 14:1227–1229.

11. Eckel F, Lersch C, Huber W, Weiss W, Berger H, Schulte-Frohlinde E. Multimicrobial sepsis including Clostridium perfringens after chemoembolization of a single liver metastasis from common bile duct cancer. Digestion. 2000; 62:208–212.

12. Urban BA, McCormick R, Fishman EK, Lillemoe KD, Petty BG. Fulminant Clostridium septicum infection of hepatic metastases presenting as pneumoperitoneum. AJR Am J Roentgenol. 2000; 174:962–964.

13. Sakurai T, Hajiro K, Takakuwa H, Nishi A, Aihara M, Chiba T. Liver abscess caused by Clostridium difficile. Scand J Infect Dis. 2001; 33:69–70.

14. Kim DH, Choi MS, Park EH, et al. Liver abscess after percutaneous radiofrequency ablation for hepatocellular carcinomas. J Korean Liver Cancer Study Group. 2005; 5:75–77.

15. Kurtz JE, Claudel L, Collard O, Limacher JM, Bergerat JP, Dufour P. Liver abscess due to clostridium septicum. A case report and review of the literature. Hepatogastroenterology. 2005; 52:1557–1558.

16. Umgelter A, Wagner K, Gaa J, Stock K, Huber W, Reindl W. Pneumobilia caused by a clostridial liver abscess: rapid diagnosis by bedside sonography in the intensive care unit. J Ultrasound Med. 2007; 26:1267–1269.

17. Saleh N, Sohail MR, Hashmey RH, Al Kaabi M. Clostridium septicum infection of hepatic metastases following alcohol injection: a case report. Cases J. 2009; 2:9408.

18. Tabarelli W, Bonatti H, Cejna M, Hartmann G, Stelzmueller I, Wenzl E. Clostridium perfringens liver abscess after pancreatic resection. Surg Infect (Larchmt). 2009; 10:159–162.

19. Ng H, Lam SM, Shum HP, Yan WW. Clostridium perfringens liver abscess with massive haemolysis. Hong Kong Med J. 2010; 16:310–312.

20. Rajendran G, Bothma P, Brodbeck A. Intravascular haemolysis and septicaemia due to Clostridium perfringens liver abscess. Anaesth Intensive Care. 2010; 38:942–945.