A rare but lethal hepatic infection: Emphysematous hepatitis - Case report and literature review

Emphysematous hepatitis (EH) is a rare and often fatal liver infection characterized by gas within the hepatic parenchyma without abscess formation. Diabetes mellitus and gastrointestinal malignancies are the main predisposing factors. Prompt diagnosis and aggressive treatment are essential due to its fulminant course. A 67-year-old male with uncontrolled type 2 diabetes and a long smoking history presented with abdominal pain, nausea, vomiting, dyspnea, and altered consciousness. Laboratory tests revealed elevated liver enzymes, hyperbilirubinemia, severe hyperglycemia, and increased inflammatory markers. Abdominal CT showed a gas-containing lesion in the left hepatic lobe without fluid collection. Due to rapid clinical deterioration, emergency surgical resection was performed. Despite postoperative intensive care and meropenem therapy, the patient died six hours after surgery. Cultures grew E. coli and Enterobacter hormaechei. Only 19 EH cases have been reported to date. Most patients are elderly and have diabetes. Diagnosis relies on CT imaging, which reveals intrahepatic gas without abscess. Pathogenesis may involve anaerobic bacterial fermentation and microcirculatory impairment in diabetic patients. Despite antibiotics and drainage, mortality remains high. EH should be considered in diabetic patients with sepsis and intrahepatic gas on CT. Early diagnosis and immediate intervention-including antimicrobial therapy and drainage-are critical to improving survival.