Infection and Drug Resistance (Aug 2023)

Clostridium perfringens Liver Abscess Disguised as Biliary Disease: A Report of Two Cases and a Review of the Literature

  • Peng J,
  • Zhai Q,
  • Li J,
  • Chen X,
  • Wu H,
  • Zhong T,
  • Tang G,
  • Yu D,
  • He L,
  • Li J

Journal volume & issue
Vol. Volume 16
pp. 5209 – 5222

Abstract

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Jialun Peng,1,* Qilong Zhai,1,* Jinzheng Li,1 Xingyu Chen,1 Hongyu Wu,1 Tao Zhong,1 Gangyi Tang,2 Dajun Yu,2 Lixian He,2 Jinxu Li2 1Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China; 2Department of General Surgery, Wushan County People’s Hospital of Chongqing, Chongqing, 404700, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jinzheng Li; Gangyi Tang, Tel +86 138 9600 6584 ; +86 159 2387 3984, Fax +86 023 6369 3000, Email [email protected]; [email protected]: Liver abscesses caused by Clostridium perfringens are rare but rapidly fatal. In only a few days, patients progress from liver abscess to sepsis, intravascular hemolysis, multiple organ failure, and even death. These abscesses often occur in patients after trauma or surgery or in those with immunodeficiency. Because patients only show non-specific symptoms such as fever and abdominal pain in the early stage, they can easily be misdiagnosed and miss the therapeutic window, resulting in a poor prognosis. The diagnosis of Clostridium perfringens liver abscess mainly depends on computed tomography (CT), needle aspiration, and/or blood culture. After diagnosis, treatments such as antibiotic therapy, surgical abscess drainage, blood transfusion as needed, and correction of metabolic disturbances must be immediately administered to prevent severe complications. Here, we present two cases of liver abscess due to Clostridium perfringens infection. Both patients initially presented only with fever, abdominal pain, and jaundice, symptoms that were easily confused with cholangitis caused by cholelithiasis. The patients then progressed rapidly and, despite receiving antimicrobial and multimodal sepsis treatment, both eventually died of multiple organ dysfunction syndrome. Clinicians should be on high alert for Clostridium perfringens liver abscesses disguised as biliary disease. Early diagnosis and treatment with the appropriate antibiotics and surgery are fundamental for the survival of the affected patients.Keywords: intravascular hemolysis, biliary diseases, diagnosis, treatment

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