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Clostridium perfringens Bacteremia in an 85-Year-Old Diabetic Man.

Mirrakhimov AE, Chandra G, Voore P, Khan M, Halytskyy O, Elhassan A, Ali AM - Case Rep Gastroenterol (2014)

Bottom Line: Common risk factors for this disease include male gender, old age, presence of diabetes mellitus and cholelithiasis.The disease is best treated with emergent surgery and parenteral antibiotics.We present the case of an 85-year-old nursing home resident who presented to our institution with a 3-day history of gradually worsening abdominal discomfort.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Saint Joseph Hospital, Chicago, Ill., USA.

ABSTRACT
Emphysematous cholecystitis is an uncommon and dangerous complication of acute cholecystitis. Common risk factors for this disease include male gender, old age, presence of diabetes mellitus and cholelithiasis. The disease is best treated with emergent surgery and parenteral antibiotics. We present the case of an 85-year-old nursing home resident who presented to our institution with a 3-day history of gradually worsening abdominal discomfort.

No MeSH data available.


Related in: MedlinePlus

Abdominal CT scan showing emphysematous cholecystitis with gas within its wall (white arrow) and lumen (yellow arrow) as well as free gas adjacent to the liver (red arrow) due to gallbladder perforation.
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Figure 1: Abdominal CT scan showing emphysematous cholecystitis with gas within its wall (white arrow) and lumen (yellow arrow) as well as free gas adjacent to the liver (red arrow) due to gallbladder perforation.

Mentions: Complete blood count, comprehensive metabolic panel, amylase, lipase, prothrombin time/INR, troponin and blood cultures were done. White blood cell count was 10.2 × 103/mm3 (normal range 4–11) with a slight increase in neutrophil number, platelet count was normal and hemoglobin was slightly decreased at 11.2 g/dl (normal range 13–17). Creatinine was found to be elevated at 1.99 mg/dl (normal range 0.6–1.3), increasing from his baseline of 0.92 mg/dl. Aspartate aminotransferase was 58 IU/l (normal range 13–39), total bilirubin was 1.5 mg/dl (normal range 0.3–1.0), glucose 292 mg/dl (normal range 70–99) and INR 1.7 (normal range 0.9–1.1). Amylase, lipase, troponin, lactic acid and other parameters were within normal limits. Right upper quadrant ultrasound was done and showed gallbladder wall thickening consistent with cholecystitis. The patient was given 1 l of lactated Ringer's solution and started on combination of intravenous levofloxacin and metronidazole, which were later changed to piperacillin-tazobactam. Approximately 2 h later the patient complained of worsening abdominal pain, including the right lower quadrant. Abdominal and pelvic CT scan with oral contrast was ordered to look for causes of his deterioration. CT scan showed emphysematous cholecystitis with perforation and pneumoperitoneum (fig. 1). The surgical team was asked to evaluate the patient. He was taken directly to the operating room the same day for emergent cholecystectomy. In the operating room evidence of gangrenous transformation of the gallbladder and biliary leak into the peritoneum was noted. The patient tolerated the surgery well. On the fifth day of his stay, blood cultures result came back positive for β-lactamase-negative Clostridium perfringens sensitive to amoxicillin-clavulanic acid. The patient was discharged back to his nursing home on postoperative day 14 in stable condition to continue oral amoxicillin-clavulanic acid for 14 more days.


Clostridium perfringens Bacteremia in an 85-Year-Old Diabetic Man.

Mirrakhimov AE, Chandra G, Voore P, Khan M, Halytskyy O, Elhassan A, Ali AM - Case Rep Gastroenterol (2014)

Abdominal CT scan showing emphysematous cholecystitis with gas within its wall (white arrow) and lumen (yellow arrow) as well as free gas adjacent to the liver (red arrow) due to gallbladder perforation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4307004&req=5

Figure 1: Abdominal CT scan showing emphysematous cholecystitis with gas within its wall (white arrow) and lumen (yellow arrow) as well as free gas adjacent to the liver (red arrow) due to gallbladder perforation.
Mentions: Complete blood count, comprehensive metabolic panel, amylase, lipase, prothrombin time/INR, troponin and blood cultures were done. White blood cell count was 10.2 × 103/mm3 (normal range 4–11) with a slight increase in neutrophil number, platelet count was normal and hemoglobin was slightly decreased at 11.2 g/dl (normal range 13–17). Creatinine was found to be elevated at 1.99 mg/dl (normal range 0.6–1.3), increasing from his baseline of 0.92 mg/dl. Aspartate aminotransferase was 58 IU/l (normal range 13–39), total bilirubin was 1.5 mg/dl (normal range 0.3–1.0), glucose 292 mg/dl (normal range 70–99) and INR 1.7 (normal range 0.9–1.1). Amylase, lipase, troponin, lactic acid and other parameters were within normal limits. Right upper quadrant ultrasound was done and showed gallbladder wall thickening consistent with cholecystitis. The patient was given 1 l of lactated Ringer's solution and started on combination of intravenous levofloxacin and metronidazole, which were later changed to piperacillin-tazobactam. Approximately 2 h later the patient complained of worsening abdominal pain, including the right lower quadrant. Abdominal and pelvic CT scan with oral contrast was ordered to look for causes of his deterioration. CT scan showed emphysematous cholecystitis with perforation and pneumoperitoneum (fig. 1). The surgical team was asked to evaluate the patient. He was taken directly to the operating room the same day for emergent cholecystectomy. In the operating room evidence of gangrenous transformation of the gallbladder and biliary leak into the peritoneum was noted. The patient tolerated the surgery well. On the fifth day of his stay, blood cultures result came back positive for β-lactamase-negative Clostridium perfringens sensitive to amoxicillin-clavulanic acid. The patient was discharged back to his nursing home on postoperative day 14 in stable condition to continue oral amoxicillin-clavulanic acid for 14 more days.

Bottom Line: Common risk factors for this disease include male gender, old age, presence of diabetes mellitus and cholelithiasis.The disease is best treated with emergent surgery and parenteral antibiotics.We present the case of an 85-year-old nursing home resident who presented to our institution with a 3-day history of gradually worsening abdominal discomfort.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Saint Joseph Hospital, Chicago, Ill., USA.

ABSTRACT
Emphysematous cholecystitis is an uncommon and dangerous complication of acute cholecystitis. Common risk factors for this disease include male gender, old age, presence of diabetes mellitus and cholelithiasis. The disease is best treated with emergent surgery and parenteral antibiotics. We present the case of an 85-year-old nursing home resident who presented to our institution with a 3-day history of gradually worsening abdominal discomfort.

No MeSH data available.


Related in: MedlinePlus