A middle-aged lady with a pyogenic liver abscess caused by Clostridium perfringens

Abstract

The pyogenic liver abscess caused by Clostridium perfringens (C. perfringens) is a rare, but rapidly fatal infection. It is usually associated with malignancy and immunosuppression. We report the case of 50-year-old lady with the secondary liver metastases from rectal cancer presented with fever and epigastric pain. The identification of Gram-positive bacilli septicaemia, the presence of gas-forming liver abscess and massive intravascular hemolysis should lead to the suspicion of C. perfringens infection. Here we review twenty cases published since 1990 and their clinical features are discussed. The importance of "an aggressive treatment policy" with multidisciplinary team approach is emphasized.

Keywords: Clostridium perfringens; Gram-positive bacilli septicaemia; Infected hepatic metastases; Liver abscess; Pyogenic liver abscess.

Figure 1

Ultrasound of liver showed mixed heterogeneous echogenicity lesions. Ill defined internal hyperechogenicity with “dirty shadow” appearance suspicious of gas content.

Figure 2

Axial (A) and sagittal (B) contrast multi-detector computerized tomography scan of abdomen. Rim-enhancing cystic lesions with internal gas content occupying both hepatic lobes with the largest occupying the right lobe.