Authors: Yuko Okui , Yuka Saeki , Yuka Nakajima , Masahiko Kambe

Abstract

Background:

Gas-forming liver abscess caused by Clostridium perfringens is extremely rare but carries a high mortality rate. Early recognition of hemolysis and hepatic gas formation is critical for timely management.

Case Presentation:

An 80-year-old man with type 2 diabetes mellitus and a history of gastrectomy for gastric ulcer presented with fever, headache, abdominal discomfort, and nausea. He had undergone endoscopic retrograde cholangiopancreatography (ERCP) four times over the previous ten months, most recently three weeks before admission. On arrival, he was alert but appeared ill, with fever, tachypnea, jaundice, and an oxygen requirement of 2 L/min via nasal cannula. His abdomen was distended and tender. Laboratory tests showed leukocytosis, anemia, elevated liver enzymes, and severe hemolysis. A plain CT scan obtained at presentation revealed a 2.3-cm gas-forming lesion in hepatic segment 6. Two hours later, contrast-enhanced CT demonstrated enlargement to 4.6 cm. Empiric broad-spectrum antibiotics (sulbactam/ampicillin) were started, and percutaneous drainage was planned. Despite treatment, the patient developed cardiac arrest seven hours after arrival and died nine hours after presentation. Blood cultures later identified C. perfringens.

Discussion:

C.perfringens liver abscess is rare but highly aggressive. Reported risk factors include diabetes mellitus, advanced age, previous gastrointestinal surgery, and recent hepatobiliary procedures such as ERCP. Characteristic findings are hemolysis and gas formation within the liver. When this infection is suspected, prompt initiation of broad-spectrum antimicrobial therapy and urgent drainage are essential to improve outcomes.

Conclusion:

This case illustrates the fulminant course of C. perfringens liver abscess following ERCP in a diabetic patient. Early recognition, rapid antibiotic administration, and immediate drainage are critical steps to improve survival in this life-threatening condition.

Keywords: Clostridium perfringens, Sepsis, Liver abscess, Hemolysis, case report