Abstract
Liver abscess caused by Clostridium perfringens is very rare, but its clinical course can be fulminant and fatal. An 84-year-old woman, who had undergone pancreaticoduodenectomy for bile duct cancer twelve years earlier, was seen at the emergency clinic in our hospital for shaking chills and fever. An abdominal computed tomography revealed a low density area containing gas in the segment 5 of the liver. After admission, she developed abdominal pain and the liver abscess enlarged rapidly on enhanced CT. Laboratory data showed extremely high inflammatory response and intravascular hemolysis. The pathogene of the liver abscess was judged to be an aerogen. Because systemic antibiotics treatment was ineffective, percutaneous transhepatic abscess drainage was performed. Gram stain of the drainage content fluid demonstrated gram-positive rods and we suspected of Clostridium perfringens infection. Despite the drainage and antibiotics, intravascular hemolysis took downhill course and the patient went into shock with multiple organ failure. Finally, she died twenty hours after admission. Clostridium perfringens was identified from cultures of the blood and the drainage fluid after her death.
