Case Report
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World J Diabetes. Apr 15, 2014; 5(2): 224-229
Published online Apr 15, 2014. doi: 10.4239/wjd.v5.i2.224
Gas-forming liver abscess associated with rapid hemolysis in a diabetic patient
Miwa Kurasawa, Takashi Nishikido, Junko Koike, Shin-ichi Tominaga, Hiroyuki Tamemoto
Miwa Kurasawa, Takashi Nishikido, Department of Internal Medicine, Nishi-agatsuma Welfare Hospital, Naganohara-machi, Agatsuma-gun, Gunma Prefecture 377-1308, Japan
Junko Koike, Clinical Laboratory, Nishi-agatsuma Welfare Hospital, Naganohara-machi, Agatsuma-gun, Gunma Prefecture 377-1308, Japan
Shin-ichi Tominaga, Hiroyuki Tamemoto, Department of Biochemistry, Jichi Medical University, Shimotsuke City, Tochigi Prefecture 329-0498, Japan
Author contributions: Kurasawa M designed the report; Kurasawa M, Nishikido T and Koike J collected the patient’s data; Tominaga S and Tamemoto H analyzed the data and wrote the paper.
Correspondence to: Hiroyuki Tamemoto, MD, PhD, Associate Professor, Department of Biochemistry, Jichi Medical University, Yakushiji 3311-1, Shimotsuke City, Tochigi Prefecture 329-0498, Japan. tamemoto@jichi.ac.jp
Telephone: +81-285-587324 Fax: +81-285-442158
Received: November 28, 2013
Revised: March 10, 2014
Accepted: March 17, 2014
Published online: April 15, 2014
Processing time: 140 Days and 18.1 Hours
Abstract

We experienced a case of liver abscess due to Clostridium perfringens (CP) complicated with massive hemolysis and rapid death in an adequately controlled type 2 diabetic patient. The patient died 6 h after his first visit to the hospital. CP was later detected in a blood culture. We searched for case reports of CP septicemia and found 124 cases. Fifty patients survived, and 74 died. Of the 30 patients with liver abscess, only 3 cases survived following treatment with emergency surgical drainage. For the early detection of CP infection, detection of Gram-positive rods in the blood or drainage fluid is important. Spherocytes and ghost cells indicate intravascular hemolysis. The prognosis is very poor once massive hemolysis occurs. The major causative organisms of gas-forming liver abscess in diabetic patients are Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli). Although CP is relatively rare, the survival rate is very poor compared with those of K. pneumoniae and E. coli. Therefore, for every case that presents with a gas-forming liver abscess, the possibility of CP should be considered, and immediate aspiration of the abscess and Gram staining are important.

Keywords: Liver abscess; Gas-forming; Clostridium perfringens; Hemolysis; Diabetes

Core tip: Gas-forming liver abscess caused by Clostridium perfringens can result in massive hemolysis and death within several hours. For survival, urgent surgical intervention and antibiotic administration are necessary.