Fulminant liver failure following infection by Clostridium perfringens.
BACKGROUND
Since the first description of gas gangrene of an internal organ by Fraenkel in 1889, few cases of acute organ failure following Clostridium perfringens infection have been described in the medical literature. Isolated Clostridium perfringens infection with subsequent sepsis syndrome is an extremely rare clinical syndrome. A consecutive pattern of multiple organ failure generally has a very high mortality rate.


METHODS
Individual case report and literature review.


RESULTS
A 58-year-old male patient developed fulminant necrotic liver failure following a Clostridium perfringens infection. Despite all intensive care measures, including computed tomography-guided drainage, the condition of the patient deteriorated rapidly and the patient died. In this case report, we characterize the symptoms of gas gangrene isolated to the liver and compare the treatment measures instituted with the medical literature.


CONCLUSIONS
In our presented case, primary malignant disease of the papilla of Vater and resection by a Whipple procedure with a hepatico-jejunostomy were a decisive cause of the gas gangrene in the liver. The origin is probably ascension up the common hepatic duct of gut-derived bacteria.
Bergert
Hendrik
H
Department of Visceral, Thoracic and Vascular Surgery, University Hospital of the Technical University of Dresden, Dresden, Germany. hendrickbergert@web.de
Illert
Till
T
Friedrich
Katrin
K
Ockert
Detlef
D
D001707:Biopsy, Needle; D003015:Clostridium Infections / Q000175:diagnosis* / Q000628:therapy; D003016:Clostridium perfringens / Q000302:isolation & purification*; D003131:Combined Modality Therapy; D018450:Disease Progression; D017809:Fatal Outcome; D006801:Humans; D007150:Immunohistochemistry; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis* / Q000628:therapy; D014057:Tomography, X-Ray Computed