Fulminant Clostridium perfringens Hepatic Gas Gangrene: Successful Recovery Monitored by Serial Ultrasonography

Hepatic gas gangrene caused by Clostridium perfringens is an extremely rare and fulminant infection characterized by rapid tissue necrosis and gas production. A 74-year-old male with septic shock, massive rhabdomyolysis (creatine kinase >20,350 U/L), and anuric acute kidney injury was admitted. Initial ultrasonography revealed diffuse hyperechoic foci with prominent dirty shadowing artifacts in the right hepatic lobe, consistent with emphysematous changes. Computed tomography (CT) confirmed a 7.4-cm loculated air collection. C. perfringens was identified in blood and abscess cultures. The patient was successfully managed with early percutaneous catheter drainage, continuous renal replacement therapy, and prolonged clindamycin therapy for toxin inhibition. This case highlights the critical role of ultrasonography in the early recognition of hepatic gas gangrene and the necessity of aggressive multidisciplinary intervention for survival.