A case of fatal Clostridium perfringens bacteremia and sepsis following CT-guided liver biopsy of a rare neuroendocrine
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CASE REPORT
A case of fatal Clostridium perfringens bacteremia and sepsis following CT-guided liver biopsy of a rare neuroendocrine hepatic tumor Gianluca Landi 1 & Giacomo Gualtieri 1 & Irini Scordi Bello 2 & Daniel Kirsch 2
Accepted: 5 November 2016 # Springer Science+Business Media New York 2017
Introduction Clostridium perfringens, formerly known as Clostridium welchii, is an anaerobic, Gram-positive, spore-forming bacillus [1–3]. Clostridia are ubiquitous organisms found in soil and water, as well as in the gastro-intestinal and urogenital tract of healthy humans [1, 4]. Some Clostridia, like Clostridium botulinum, Clostridium tetani and Clostridium difficile are pathogenic to humans and animals [3, 5–7]. Clostridium perfringens has the ability to cause disease in humans and animals, because of its rapid growth, spore formation, and toxin production. The clinical presentation of C. perfringens infection includes a variety of manifestations, such as gas gangrene, emphysematous cholecystitis, crepitant cellulitis, fasciitis and myositis [4, 8–10]. The main toxin is the α-toxin, an enzyme that splits lecithin into phosphocholine and diglyceride, causing damage to red blood cell membranes, leading to spherocytosis and subsequent intravascular hemolysis [3, 11, 12] Once inside the body, this organism can also perform anaerobic fermentation, producing large amounts of gaseous waste products [13–15].
* Gianluca Landi [email protected] Giacomo Gualtieri [email protected] Irini Scordi Bello [email protected] Daniel Kirsch [email protected] 1
Section of Legal Medicine, University of Siena, Siena, Italy
2
The Office of Chief Medical Examiner, New York City, NY, USA
The mortality rate of patients with Clostridium perfringens bacteremia is 27–44%; in 7%–15% of cases, hemolysis complicates the sepsis, raising the mortality to 70%–100% [7, 16–18]. The early clinical symptoms of C. perfringens infection are non-specific, which leads to considerable difficulty with diagnosis [19–22]. Early recognition and initiation of appropriate antibiotic treatment and surgical intervention or drainage is essential [18, 19]. In some instances, the initial presenting symptom is anemia, with a raised mean cell hemoglobin concentration and a reduced mean cell volume, in conjunction with hemoglobinemia and hemoglobinuria [10, 23, 24]. Gram-positive rods on a peripheral blood smear and positive blood or tissue culture confirm the diagnosis. A plain radiograph of the abdomen may reveal the presence of abscesses or gas in tissues [2].
Case report A 50-year-old morbidly obese man (BMI 74.6 kg/m2) with hypertension, diabetes, osteoarthritis, and hypothyroidism was admitted to the hospital with complains of right upper quadrant abdominal pain and unintentional weight loss of one month’s duration. Physical examination was remarkable for moderate pain on palpation of the epigastric and right flank zones, without signs of peritoneal irritation. An endoscopic gastroduodenoscopy (EGD) and a colonoscopy were negative. An
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