S3210 Unraveling Extrapulmonary Sarcoidosis in a Patient With Unexplained Cholestatic Liver Injury

Abstract

abdominal ultrasound showed a hyperechoic focus in the right hepatic lobe corresponding to the findings on CT (Figure 1B). Ultimately, the patient was treated with two weeks of cefepime and metronidazole for her C. perfringens bacteremia with hepatic focus. Her clinical course improved with antimicrobial therapy. Hepatic function tests were within normal limits by the time of discharge. Discussion: C. perfringens causes cytotoxic infection due to its alpha toxin, a lecithinase which breaks down cell membranes leading to cell lysis. Thus, our patient's severe acute anemia is explained in part by hemolysis due to clostridial infection. This organism is an uncommon cause of gas-forming liver abscess. A prior review of 119 cases of patients with gas-forming pyogenic liver abscess found only 8 to be infected with clostridia species. Malignancy and immunosuppression are both risk factors for C. perfringens infection and septicemia, both of which are present in our patient and thus made her more susceptible to clostridial infection. The etiology of her infection was potentially a bacterial translocation from the gastrointestinal tract. Mortality rate in patients with sepsis due to C. perfringens has been previously estimated at 70-100%. Thus, prompt recognition of this clinical syndrome is paramount so that early treatment can be initiated. Early appropriate antimicrobial therapy was essential to this patient's good outcome.[3209] Figure 1. A) A CT scan of the abdomen showing a focus of gas in the right hepatic lobe (arrow). B) An ultrasound of the right upper quadrant showing focus of gas in the right hepatic lobe (arrow).