Yong K Kwon, MD, Assistant Professor of Surgery, Department of Transplant, Hartford Hospital, 85 Seymour Street, Suite 320, Hartford, CT 06106, United States. yong.kwon@hhchealth.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Mar 27, 2018; 10(3): 388-395 Published online Mar 27, 2018. doi: 10.4254/wjh.v10.i3.388
Clostridium paraputrificum septicemia and liver abscess
Yong K Kwon, Faiqa A Cheema, Bejon T Maneckshana, Caroline Rochon, Patricia A Sheiner
Yong K Kwon, Faiqa A Cheema, Bejon T Maneckshana, Caroline Rochon, Patricia A Sheiner, Department of Transplant, Hartford Hospital, Hartford, CT 06106, United States
Author contributions: Kwon YK and Cheema FA wrote the initial manuscript; Maneckshana BT, Rochon C and Sheiner PA performed a literature search and analyzed the data; all authors contributed equally to editing and revising the final manuscript.
Informed consent statement: Written informed consent and permission to write this manuscript was obtained from the patient of this case report.
Conflict-of-interest statement: The authors certify that we have no conflict of interest to disclose and did not receive any financial support for this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yong K Kwon, MD, Assistant Professor of Surgery, Department of Transplant, Hartford Hospital, 85 Seymour Street, Suite 320, Hartford, CT 06106, United States. yong.kwon@hhchealth.org
Telephone: +1-860-6962030 Fax: +1-860-5491476
Received: December 19, 2017 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
ARTICLE HIGHLIGHTS
Case characteristics
A healthy 23-year-old female developed a Clostridium paraputrificum gas forming liver abscess within 24 h after interventional radiology hepatic adenoma embolization.
Clinical diagnosis
The patient’s source of sepsis was unequivocally identified once an imaging study showed a gas forming liver abscess.
Differential diagnosis
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.
Laboratory diagnosis
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.
Imaging diagnosis
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.
Pathological diagnosis
A needle aspiration of the hepatic abscess and/or blood culture often will yield the causative organism.
Treatment
An early recognition and treatment with antibiotics is paramount as Clostridium hepatic abscess infections are often extremely aggressive and lethal.
Related reports
There have been five case reports of septicemia caused by C. paraputrificum, however, none of them caused hepatic abscess.
Term explanation
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.
Experiences and lessons
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.
