An autopsy case of hepatocellular carcinoma, which developed a fatal massive hemolysis as a complication of Clostridium perfringens infection after transarterial chemoembolization

Abstract

A 74-year-old woman was diagnosed as HCV cirrhosis and diabetes mellitus in 2003. She received transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) 4 times from 2006. Recurrence of HCC was suspected from a subsequent abdominal CT scan. HCC was diagnosed from angiography, and TACE was performed. After TACE, she experienced frequent vomiting and epigastric pain. From the fourth day after TACE, she showed a high fever and was treated with symptomatic therapy. At the 6^th night after TACE, she experienced cardiopulmonary arrest. Cardiopulmonary resuscitation was performed immediately, but it was unsuccessful. Laboratory data for cardiopulmonary arrest showed severe anemia and jaundice.
Autopsy was performed. The aorta was reddish. Pathological findings showed growth of gram-positive bacilli in each organ of the body. Clostridium perfringens (C. perfringens) was detected in a blood culture taken at post-TACE day 5. The cause of her death was considered to be C. perfringens septicemia and massive hemolysis. There are few case reports of C. perfringens sepsis complicated with massive hemolysis after TACE. This report is added for consideration.