Clostridium clostridioforme liver abscess complicated by portal vein thrombosis in childhood

Abstract

Pyogenic liver abscesses are rare in children, and show geographical differences in their epidemiology. Mortality rates remain high at 15 %. Liver abscesses caused by anaerobic organisms are rare in a paediatric setting, even more so when complicated by portal vein thrombosis (PVT). A 6-year-old girl, previously fit and well, was admitted with fever, lethargy and weight loss of 2 weeks duration. The patient was febrile on examination and a review of the systems revealed no positive findings. An abdominal ultrasound scan showed multiple interconnecting cystic lesions consistent with liver abscesses, which was confirmed by a computed tomography scan. Aspirate of the abscess was cultured, resulting in the isolation of a non-haemolytic anaerobic organism, which was difficult to identify using conventional phenotypic identification tests. 16S rRNA typing identified the organism as Clostridium clostridioforme. The liver abscess in our patient displayed a particularly aggressive clinical course with extension of the abscess to involve the upper pole of the right kidney and the appendix, which was further complicated by PVT. The role of anaerobic organisms in liver abscesses has been underreported in the past. This case, therefore, highlights the importance of incubating biological samples in anaerobic conditions in order to adequately isolate and identify anaerobic bacteria, particularly those associated with abscesses.

Suppurative Thrombosis of the Portal Vein (Pylephlebits): A Systematic Review of Literature

“…Articles published in languages other than English; cases where clinical, microbiological, or radiological studies did not support the diagnosis; case reports not providing an adequate amount of information, as well as those reporting non-human subjects were excluded from the analyses. The final number of articles included was 101, which resulted in total number of 103 patients [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ,…”

Liver Abscesses as Pseudotumoral Lesions

“…Clostridium species are a known cause of liver abscesses, in part with gas formation (Fiese 1950;Kivel et al 1958;Sarmiento and Sarr 2002;Kurtz et al 2005;Tabarelli et al 2009;Ng et al 2010;Rajendran et al 2010;Huang et al 2012;Ogah et al 2012). Clostridial species causing liver abscess include C. perfringens, C. clostridioforme, C. baratii, C. septicum, and C. welchii.…”

“…In part of these PLA, the bacteria causing the infection express formic hydrogen lyase, leading to mixed acid fermentation and gas formation. Etiologically, classical gas-forming bacteria may be involved (such as Clostridia; Kahn et al 1972;Ogah et al 2012), but at least 75 % of all gas-containing PLA have been found to be caused by Escherichia coli and Klebsiella (Zhang et al 2013). Other germs inducing gas-forming PLA are Salmonella enteritidis (Tee Yu et al 2013) and diverse anaerobic bacteria.…”

“…Less common bacteria causing or having been isolated from PLA comprise Staphylococcus aureus (Smith et al 2007), Pseudomonas aeruginosa (Goldani et al 2005), Enterococcus species (Thomas et al 1983), Bacteroides fragilis (Lonardo et al 1992), Streptococcus mitis (Sarthe and DiBardino 2013), Streptococcus anginosus (Giuliano et al 2012), Aeromonas sobria (Kamano et al 2003), Citrobacter koseri (Gupta et al 2013), Aggregatibacter aphrophilus (Tsui et al 2012), Yersinia enterocolitica (Pulvirenti et al 2007), Fusobacterium necrophorum (Hagelskjaer and Pedersen 1993;Athavale et al 2002;Thatcher 2003), periodontal bacteria (Fusobacterium nucleatum, Treponema denticola, Prevotella intermedia, Porphyromonas gingivalis; Ohyama et al 2009), several anaerobic bacteria (Sabbai et al 1972;Ogah et al 2012), and a large number of other germs, which have in part been observed in immunocompromised patients.…”

“…Gas-forming hepatic abscess can develop as a complication of arterial infusion chemotherapy (D'Orsi et al 1979). Clostridial hepatic abscess may show a highly aggressive course, with extension of the abscess into adjacent organs (including the right kidney and the intestinal tract) and induction of portal vein thrombosis (Ogah et al 2012). Liver abscess caused by C. perfringens can be followed by massive intravascular hemolysis (Kreidl et al 2002;Au and Lau 2005;Ng et al 2010), or intravascular hemolysis and septicemia (Rajendran et al 2010).…”