Limits...
Intravascular Hemolysis and Septicemia due to Clostridium perfringens Emphysematous Cholecystitis and Hepatic Abscesses.

Cochrane J, Bland L, Noble M - Case Rep Med (2015)

Bottom Line: Context.Conclusion.Hyperbaric oxygen therapy may reduce mortality.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Residency of Spokane, University of Washington Medical School, Spokane, WA 99204, USA.

ABSTRACT
Context. Clostridium perfringens septicemia is often associated with translocation from the gastrointestinal or gastrourinary tract and occurs in patients who have malignancy or are immunocompromised. Clostridium perfringens septicemia is usually fatal without early identification, source control, and antibiotics. Case. We present a case of a 65-year-old female with Clostridium perfringens septicemia secondary to emphysematous cholecystitis, with progression to hepatic abscesses. Conclusion. Septicemia secondary to Clostridium perfringens is generally fatal if not detected early. Source control with surgery or percutaneous drainage and early antibiotic therapy is imperative. Hyperbaric oxygen therapy may reduce mortality. Clinicians caring for patients with sepsis and intravascular hemolysis must have Clostridium perfringens septicemia on their differential diagnosis with a low threshold for starting antibiotics and pursuing source of infection.

No MeSH data available.


Related in: MedlinePlus

CT abdomen/pelvis demonstrating multiple abscesses in the liver with air fluid levels.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4502316&req=5

fig1: CT abdomen/pelvis demonstrating multiple abscesses in the liver with air fluid levels.

Mentions: Over the next 36 hours she showed little improvement, developed red tinged urine, and became anemic, and evaluation revealed hemolysis. Hemoglobin declined from 13 to 8.1 g/dL, lactate dehydrogenase was found to be 5290 IU/L (normal level 140 to 280 IU/L), haptoglobin was less than 10 mg/dL (normal level 45 to 165 mg/dL), and fibrinogen and INR were normal. Peripheral smear demonstrated microspherocytes and vacuolated neutrophils with no evidence of schistocytes. Coombs test was negative. White blood cell count increased to 24 K/μL (normal level 4.5 to 10 K/μL) and creatinine increased from 1.0 mg/dL to 2.0 mg/dL. She became hemodynamically unstable with pulse 130 beats per minute, blood pressure 105/50 mmHg, and temperature 103.5 F. Additional testing demonstrated venous lactate 46 mEq/L (normal level 0.5–2.2 mEq/L), ALT 407 IU/L (normal level 7–56 IU/L), AST 1200 IU/L (normal level 0–56 IU/L), ALP 300 IU/L (normal level 44 to 147 IU/L), and total bilirubin 9.6 mg/dL (normal level 0.3 to 1.9 mg/dL). Urine analysis demonstrated 4+ blood on the dipstick with few red blood cells on microscopy. The constellation of hemolysis with sepsis raised the clinical suspicion for C. perfringens infection and she was started on high dose Penicillin G 12 million units daily and Clindamycin 900 mg every 8 hours. Hyperbaric oxygen therapy was unavailable. Repeat CT abdomen/pelvis without contrast demonstrated hepatic abscesses (Figure 1).


Intravascular Hemolysis and Septicemia due to Clostridium perfringens Emphysematous Cholecystitis and Hepatic Abscesses.

Cochrane J, Bland L, Noble M - Case Rep Med (2015)

CT abdomen/pelvis demonstrating multiple abscesses in the liver with air fluid levels.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4502316&req=5

fig1: CT abdomen/pelvis demonstrating multiple abscesses in the liver with air fluid levels.
Mentions: Over the next 36 hours she showed little improvement, developed red tinged urine, and became anemic, and evaluation revealed hemolysis. Hemoglobin declined from 13 to 8.1 g/dL, lactate dehydrogenase was found to be 5290 IU/L (normal level 140 to 280 IU/L), haptoglobin was less than 10 mg/dL (normal level 45 to 165 mg/dL), and fibrinogen and INR were normal. Peripheral smear demonstrated microspherocytes and vacuolated neutrophils with no evidence of schistocytes. Coombs test was negative. White blood cell count increased to 24 K/μL (normal level 4.5 to 10 K/μL) and creatinine increased from 1.0 mg/dL to 2.0 mg/dL. She became hemodynamically unstable with pulse 130 beats per minute, blood pressure 105/50 mmHg, and temperature 103.5 F. Additional testing demonstrated venous lactate 46 mEq/L (normal level 0.5–2.2 mEq/L), ALT 407 IU/L (normal level 7–56 IU/L), AST 1200 IU/L (normal level 0–56 IU/L), ALP 300 IU/L (normal level 44 to 147 IU/L), and total bilirubin 9.6 mg/dL (normal level 0.3 to 1.9 mg/dL). Urine analysis demonstrated 4+ blood on the dipstick with few red blood cells on microscopy. The constellation of hemolysis with sepsis raised the clinical suspicion for C. perfringens infection and she was started on high dose Penicillin G 12 million units daily and Clindamycin 900 mg every 8 hours. Hyperbaric oxygen therapy was unavailable. Repeat CT abdomen/pelvis without contrast demonstrated hepatic abscesses (Figure 1).

Bottom Line: Context.Conclusion.Hyperbaric oxygen therapy may reduce mortality.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Residency of Spokane, University of Washington Medical School, Spokane, WA 99204, USA.

ABSTRACT
Context. Clostridium perfringens septicemia is often associated with translocation from the gastrointestinal or gastrourinary tract and occurs in patients who have malignancy or are immunocompromised. Clostridium perfringens septicemia is usually fatal without early identification, source control, and antibiotics. Case. We present a case of a 65-year-old female with Clostridium perfringens septicemia secondary to emphysematous cholecystitis, with progression to hepatic abscesses. Conclusion. Septicemia secondary to Clostridium perfringens is generally fatal if not detected early. Source control with surgery or percutaneous drainage and early antibiotic therapy is imperative. Hyperbaric oxygen therapy may reduce mortality. Clinicians caring for patients with sepsis and intravascular hemolysis must have Clostridium perfringens septicemia on their differential diagnosis with a low threshold for starting antibiotics and pursuing source of infection.

No MeSH data available.


Related in: MedlinePlus