Fulminant Emphysematous Hepatic Abscesses Due to Clostridium perfringens With Massive Intravascular Hemolysis: A Case Report

Clostridium perfringens is a gram-positive, anaerobic, gas-forming bacterium that can cause fulminant sepsis.Its alpha-toxin may induce massive intravascular hemolysis, and gas-forming hepatic infection with this organism often progresses to death within hours.An 80-year-old man presented to the emergency department with acute epigastric pain radiating to the back, tachycardia, hypertension, and fever.Triple-phase computed tomography demonstrated two gasforming hepatic abscesses in segments 7 and 8 with portal venous gas, while the gallbladder appeared normal.He developed a severe high anion gap metabolic acidosis, hyperkalemia, and indirect hyperbilirubinemia with a low haptoglobin and a rapid hemoglobin drop, consistent with massive intravascular hemolysis.Percutaneous drainage could not be performed because of rapid hemodynamic deterioration.He suffered a cardiac arrest with transient return of spontaneous circulation, followed by a second, fatal arrest two hours and 11 minutes after presentation.Blood cultures drawn at presentation grew C. perfringens, Enterococcus faecalis, and Serratia marcescens, and post-mortem examination with culture of the gallbladder wall identified the gallbladder as the primary source of infection.This case illustrates that gas-forming hepatic abscesses combined with unexplained hemolysis should immediately raise suspicion of C. perfringens sepsis and that a radiologically normal gallbladder does not exclude it as the source.Given the extremely compressed clinical course, early recognition and emergent source control are critical.