Fulminant emphysematous hepatitis with massive intravascular haemolysis due to Clostridium perfringens infection

Area of Science:

• Infectious Diseases
• Hepatology
• Critical Care Medicine

Background:

• Clostridium perfringens is an anaerobic bacterium known for potent exotoxin production and fulminant infections.
• Liver abscesses caused by C. perfringens, particularly with hemolysis, are documented but rare.
• Emphysematous hepatitis, characterized by gas in hepatic lesions, indicates severe infection.

Purpose of the Study:

• To report an exceedingly rare case of fulminant Clostridium perfringens infection presenting as emphysematous hepatitis with severe hemolysis.
• To emphasize the clinical presentation, diagnostic challenges, and outcomes of this catastrophic condition.

Main Methods:

• Case report of an elderly male patient with multiple comorbidities.
• Clinical presentation including acute abdominal pain, vomiting, and rapid deterioration.
• Diagnostic workup involving CT scan revealing gas-containing hepatic lesions and blood cultures confirming C. perfringens.

Main Results:

• The patient exhibited rapid clinical decline with altered mental status, progressive anemia, metabolic acidosis, and multiorgan dysfunction.
• CT scan findings were consistent with emphysematous hepatitis.
• Despite prompt antimicrobial therapy and supportive care, the patient succumbed to progressive multiorgan failure within 96 hours.

Conclusions:

• This case underscores the rarity of combined fulminant hemolysis and emphysematous hepatitis due to C. perfringens.
• Highlights the critical need for prompt recognition, immediate antimicrobial intervention, and source control in such severe presentations.