Clostridium perfringens septicemia with massive hemolysis

A 65-year-old woman underwent resection of a distal common bile duct carcinoma (Whipple’s procedure). Twelve months later a single hepatic metastasis was detected and a chemoembolization was performed. Immediately after chemoembolization the patient developed a multimicrobial sepsis including Clostridium perfringens. CT scans depicted pathognomonic signs of gas-containing abscess in the necrotic liver metastasis. She was subsequently treated with broad-spectrum antibiotics, abscess drainage and hyperbaric oxygen therapy. We conclude that antibiotic prophylaxis is recommendable for chemoembolization of liver metastasis in patients with risk factors like intestinal biliary reflux (bilioenteric anastomosis or papillotomy and biliary stenting) and bile duct cancer, otherwise severe sepsis including clostridium bacteremia may occur.

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“…A severe complication of hemolysis is renal failure [5, 6]. However, in our patient, creatinine levels remained normal.…”

Section: Discussionmentioning

confidence: 80%

Multimicrobial Sepsis Including <i>Clostridium perfringens</i> after Chemoembolization of a Single Liver Metastasis from Common Bile Duct Cancer

et al. 2000

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“…The clinical presentation of C. perfringens infection includes a variety of manifestations, such as gas gangrene, emphysematous cholecystitis, crepitant cellulitis, fasciitis and myositis. It is frequently associated with septic shock and intravascular haemolysis [4][5].…”

Section: Introductionmentioning

confidence: 99%

Clostridium Perfringens Sepsis With Massive Intravascular Haemolysis: A Rare Presentation

Paulino

2012

J Med Cases

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Massive intravascular haemolysis is a rare but well-known complication of Clostridium perfringens sepsis. Presence of fever, intravascular haemolysis, numerous spherocytes in peripheral blood smear and septic shock should raise this clinical suspicion. We describe the case of a 66-year-old male who was admitted in the Emergency Room complaining of abdominal pain, vomiting, fever and dark red urine. No relevant findings in physical examination were found. Laboratory tests revealed massive intravascular haemolysis (minimum haemoglobin of 4 g/dL). Ultrasound of the upper abdomen did not show relevant findings. Six hrs later his clinical condition suddenly deteriorated, evolving to septic shock. He was promptly admitted in the Intensive Care Unit but his condition continued to deteriorate very rapidly, with severe multiple organ failure. He died a few hrs later despite full organ support and large spectrum antibiotic therapy. Clostridium perfringens was identified in blood cultures taken before death. The post-mortem evaluation revealed a high stage of body decomposition suggesting presence of gas-producing bacteria precluding the execution of the autopsy. Though this is a very rare clinical condition, the suspicion of clostridium sepsis mandates the immediate prescription of antibiotic therapy and aggressive focus control in order to change the dismal prognosis associated with this entity.

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“…C perfringens GPLA can easily develop sepsis and hemolysis with extremely high mortality rate (70%-100%). 2 To our knowledge, only 1 case of C perfringens GPLA secondary to RFA has been reported in the literature. 1 Rapid diagnosis and treatment of C perfringens GPLA are essential for saving patients' lives, 3 although many patients often develop a fever after RFA because of postablation syndrome.…”

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confidence: 90%