Recurrent bacteremia and liver abscess caused by Clostridium difficile: A case report

Abstract

Rationale: Clostridium difficile bacteremia (CDB) and liver abscess is a quite rare presentation of C. difficile infection.

Patients concerns: A 74-year-old male with primary biliary cirrhosis and hepatocellular carcinoma who underwent transarterial chemoembolization (TACE) developed a high fever on post-TACE day 14. Intravenous ceftriaxone and following meropenem were administered, however, his clinical response was poor. On post-TACE day 24, 2 sets of blood culture were taken due to elevation of C-reactive protein levels.

Diagnosis: CDB, caused by bacterial translocation.

Interventions: Intravenous vancomycin and oral metronidazole were administered for two weeks.

Outcomes: One month after recurrent CDB, the patient was re-admitted due to a liver abscess at the same site of TACE. C. difficile was isolated from the liver abscess and the patient received 6 weeks of oral metronidazole treatment. CDB and liver abscess have not recurred since completion of antibiotic treatment.

Lessons: The spore-forming ability of C. difficile may contributed to the recurrent CDB episodes and liver abscess formation in necrotic liver tissue following TACE, and long-term metronidazole therapy was considered to be effective to C. difficile liver abscess.

Figure 1

CT scan of the patient's liver showed lipiodol accumulation ((A) post-TACE day 14), and liver abscess formation (arrow) of S7 ((B) post-TACE day 87). CT = computed tomography, TACE = transarterial chemoembolization.