Published online Mar 27, 2018. doi: 10.4254/wjh.v10.i3.388
Peer-review started: December 20, 2017
First decision: January 23, 2018
Revised: January 30, 2018
Accepted: March 1, 2018
Article in press: March 1, 2018
Published online: March 27, 2018
A healthy 23-year-old female developed a Clostridium paraputrificum gas forming liver abscess within 24 h after interventional radiology hepatic adenoma embolization.
The patient’s source of sepsis was unequivocally identified once an imaging study showed a gas forming liver abscess.
Klebsiella pneumonia was suspected to be the causative organism initially as it is known to contributing 77% to 88% of all gas forming pyogenic liver abscesses.
In addition to severe leukocytosis and lactic acidosis, elevated lactate dehydrogenase, deceased haptoglobin and elevated bilirubin, signs of massive hemolysis, can be also seen in certain patients.
A gas forming liver abscess can be diagnosed with an abdominal X-ray or ultrasound, but typically a computed tomography scan is commonly used for the diagnosis.
A needle aspiration of the hepatic abscess and/or blood culture often will yield the causative organism.
An early recognition and treatment with antibiotics is paramount as Clostridium hepatic abscess infections are often extremely aggressive and lethal.
There have been five case reports of septicemia caused by C. paraputrificum, however, none of them caused hepatic abscess.
Pyogenic liver abscess (PLA) is an uncommon disease. The incidences of gas forming pyogenic liver abscess (GFPLA) also known as emphysematous liver abscess, are even rarer, contributing 6.6% to 32% of PLA.
A Clostridium hepatic abscess requires early accurate diagnosis and timely interventions, as it carries an extremely high mortality. However, depending on the exact causative clostridial species, the clinical course can vary significantly.