Intravascular Hemolysis and Septicemia due toClostridium perfringensEmphysematous Cholecystitis and Hepatic Abscesses

Abstract

Context. Clostridium perfringens septicemia is often associated with translocation from the gastrointestinal or gastrourinary tract and occurs in patients who have malignancy or are immunocompromised. Clostridium perfringens septicemia is usually fatal without early identification, source control, and antibiotics. Case. We present a case of a 65-year-old female with Clostridium perfringens septicemia secondary to emphysematous cholecystitis, with progression to hepatic abscesses. Conclusion. Septicemia secondary to Clostridium perfringens is generally fatal if not detected early. Source control with surgery or percutaneous drainage and early antibiotic therapy is imperative. Hyperbaric oxygen therapy may reduce mortality. Clinicians caring for patients with sepsis and intravascular hemolysis must have Clostridium perfringens septicemia on their differential diagnosis with a low threshold for starting antibiotics and pursuing source of infection.

Sudden death caused by Clostridium perfringens sepsis presenting as massive intravascular hemolysis

“…In the literature, like the present case, there are many MIH cases in which liver abscess was responsible for C. perfringens sepsis. 2,[10][11][12][13][14][15][16][17][18][19][20][21][22] As a cause of MIH, infections of the hepatobiliary system are more common than those of any other organs. [23][24][25][26] This can be explained by the anatomical relationship between the hepatobiliary system and the digestive tract where C. perfringens inhabits as a commensal flora.…”

“…These microscopic findings, which are pathognomonic for enzymatic toxin-related hemolysis, can be differentiated from those of mechanical red cell destruction (schistocytes), which are frequently observed as microangiopathy in DIC and hemolytic uremic syndrome. 11,20,24,32 MIH progresses rapidly, shows high mortality (>70%), and death characteristically occurs within 24 hours of presentation as the result of cardiovascular collapse. 23,26,32,40 Some MIH patients survived through a quick diagnosis and immediate treatment with the administration of an adequate dose of antibiotics, including penicillin G, prompt surgical procedure, and intensive care (e.g.…”

“…exchange transfusion and hemodialysis). [11][12][13][14]23,25,40,41,44,45 For the purpose of quick diagnosis, a high index of clinical suspicion is very important. 14,23,46 Acute-onset and rapidly progressive hemolytic anemia is a key clinical manifestation.…”

Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report

“…Several reports have described fatal C. perfringens septicemia associated with liver abscess [1, 7, 8]. Although the exact mechanisms of entry into the blood stream remain unknown, bacterial translocation may occur via portal veins in proximity to abscesses in the liver [9].…”

Clostridium perfringensSepticemia and a Bleeding Ulcer of a Jejunal Interposition: A Case Report and Short Review of the Literature

“…The recommended treatment includes aggressive surgical debridement combined with high-dose antibiotics, commonly a combination of penicillin G with clindamycin [ 6 – 8 ]. Some physicians, however, prefer imipenem combined with clindamycin [ 9 , 10 ].…”