title: Hepatic abscess-associated Clostridial bacteraemia presenting with intravascular haemolysis and severe hypertension.
abstract: Clostridium perfringens bacteraemia is a potentially fatal condition, and its early identification is paramount to maximise chances of survival. Prompt recognition of intravascular haemolysis, a known complication of C. perfringens bacteraemia, can help guide clinical decision-making before microbiology data becomes available. We present a novel finding of severe hypertension in a fatal case of Clostridial bacteraemia with massive haemolysis. A 58-year-old man with no known medical history presented to the emergency department with malaise, fever and hypertension. He developed abdominal pain and a hepatic abscess was identified on CT imaging. Within 4 h of presentation, he developed massive intravascular haemolysis, extreme hypertension, pulmonary oedema and respiratory failure. He died less than 8 h after presentation. His blood cultures subsequently grew C. perfringens. This case underscores the importance of early recognition of intravascular haemolysis complicating C. perfringens bacteraemia, and discusses the rare complication of hypertensive emergency in this setting.
authors.affiliation: Division of Emergency Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Andrew George
authors.initials: AG
authors.lastname: Lim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Kristina Elizabeth
authors.initials: KE
authors.lastname: Rudd
authors.affiliation: Division of Emergency Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Halliday
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: John Rider
authors.initials: JR
authors.lastname: Hess
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D002981:Clindamycin / Q000008:administration & dosage*; D003016:Clostridium perfringens / Q000302:isolation & purification*; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D005334:Fever / Q000209:etiology; D006461:Hemolysis; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology*; D008100:Liver Abscess / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009599:Nitroprusside / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D000959:Antihypertensive Agents; D009599:Nitroprusside; D002981:Clindamycin
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