Fulminant Emphysematous Hepatitis – A Rare Cause of Septic Shock

Abstract

Emphysematous hepatitis is a rare entity characterized by the replacement of hepatic parenchyma by gas, leading to acute liver failure. Often it occurs in patients with diabetes mellitus, liver disease or a recent history of abdominal surgery. We present a case of emphysematous hepatitis in a 74-year-old man with no recognizable risk factors. Despite the early broad-spectrum antimicrobial therapy and supportive care, the condition progressed to a fatal outcome, as seen in other case reports. Early recognition of this condition and rapid and aggressive management may improve patient outcomes.

Medical management of feline emphysematous hepatitis—A case report

“…Emphysematous hepatitis (EH) is a condition that is rarely reported in both the human and veterinary literature. EH is characterized by hepatic parenchyma replacement by gas followed by inflammation of the liver which often progresses to fulminant acute liver failure 6 . To the best of our knowledge, only 12 cases are reported in the human literature with two patients treated successfully: one via urgent laparotomy with surgical debridement and supportive therapy and one via peritoneal lavage and supportive therapy.…”

“…3,4,16 In the human literature, EH is reported predominantly in women with diabetes mellitus and/or liver disease as a predisposing comorbidity. 3,6 Other cases are reported in patients with neoplasia: cholangiocarcinoma and metastatic pancreatic neoplasia. 13,16 Clinical manifestation is nonspecific with abdominal pain and fever most commonly reported.…”

“…Treatment consists of aggressive antibiotic administration and supportive therapy. Ultimately, many of the reported cases resulted in fatality secondary to septic shock 3–6 …”

“…Few reports of emphysematous hepatitis exist in the human literature. Emphysematous hepatitis is a rapidly progressive and often fatal liver infection that can occur with uncontrolled diabetes mellitus (DM), hepatic disease, or following recent abdominal surgery 1–6 . It results in the replacement of hepatic parenchyma with gas causing acute liver failure 1–6 .…”

“…Ultimately, many of the reported cases resulted in fatality secondary to septic shock. [3][4][5][6] Emphysematous infections are rarely reported in veterinary medicine. Reported cases include emphysematous cystitis, gastritis, intestinalis/colitis, and splenitis.…”