A suspected case of Clostridium perfringens sepsis with intravascular hemolysis after transhepatic arterial chemoembolization: a case report
Abstract Introduction Sepsis due to Clostridium perfringens, one of several clostridial species, is an important cause of massive intravascular hemolysis in patients with underlying malignancies. Chronic liver diseases, immunosuppression, and presence of malignancies were risk factors for Clostridiu...
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| Format: | Article |
| Language: | English |
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BMC
2019-04-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s13256-019-2023-x |
| _version_ | 1818328111730655232 |
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| author | Haruki Uojima Mie Onoue Hisashi Hidaka Naohisa Wada Yoshiaki Tanaka Tomoyoshi Inoue Kousuke Kubota Takahide Nakazawa Akitaka Shibuya Wasaburo Koizumi |
| author_facet | Haruki Uojima Mie Onoue Hisashi Hidaka Naohisa Wada Yoshiaki Tanaka Tomoyoshi Inoue Kousuke Kubota Takahide Nakazawa Akitaka Shibuya Wasaburo Koizumi |
| author_sort | Haruki Uojima |
| collection | DOAJ |
| description | Abstract Introduction Sepsis due to Clostridium perfringens, one of several clostridial species, is an important cause of massive intravascular hemolysis in patients with underlying malignancies. Chronic liver diseases, immunosuppression, and presence of malignancies were risk factors for Clostridium perfringens sepsis. Therefore, Clostridium perfringens sepsis should always be considered in patients presenting with liver damage after chemo-embolic therapy for hepatocellular carcinoma. This case report focuses on findings characteristic of an intravascular hemolysis due to Clostridium perfringens after transhepatic arterial chemoembolization. Case presentation An 83-year-old Japanese man presented to our hospital because of a third recurrence of hepatocellular carcinoma. He had nonalcoholic steatohepatitis-related cirrhosis, and underwent radiofrequency ablation and transhepatic arterial chemoembolization therapy for hepatocellular carcinoma of S4/S8 and S2. He had a medical history of pancreatic carcinoma and underwent pylorus-preserving pancreaticoduodenectomy approximately 5 years ago. Because follow-up computed tomography showed a recurrence of the hepatocellular carcinoma, he underwent transhepatic arterial chemoembolization with a hepatic arterial infusion of 20 mg epirubicin, followed by 4 mL Lipiodol (ethiodized oil). On the sixth day after the procedure, he complained of fever and hematuria with jaundice. Laboratory findings indicated hemolysis and increased inflammatory response. Although we initiated antibiotic therapy combined with surgical debridement for infection after transhepatic arterial chemoembolization, he died within 6 hours. The autopsy showed a 4-cm local necrotic hepatic tumor. The cut surface revealed a tumor with an internal spongiform appearance, which was a pseudocystic and partially necrotic lesion. In addition, a diffuse spread of Gram-positive rods in multiple organs including the heart was histologically confirmed. The culture obtained by fluid aspiration from the hepatic abscess revealed Clostridium perfringens. Although the role of Clostridium perfringens was never established during the life of this patient, based on the clinical course and the culture from the hepatic abscess at postmortem, intravascular hemolysis secondary to Clostridium perfringens sepsis was suspected. Conclusion Intravascular hemolysis secondary to Clostridium perfringens should always be considered in patients presenting with liver damage after chemo-embolic therapy for hepatocellular carcinoma. Biliary reconstruction is an especially important risk factor for infection. |
| first_indexed | 2024-12-13T12:26:58Z |
| format | Article |
| id | doaj.art-90d8d3d48c5c4451980c16d1d40f294d |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-13T12:26:58Z |
| publishDate | 2019-04-01 |
| publisher | BMC |
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| series | Journal of Medical Case Reports |
| spelling | doaj.art-90d8d3d48c5c4451980c16d1d40f294d2022-12-21T23:46:15ZengBMCJournal of Medical Case Reports1752-19472019-04-011311710.1186/s13256-019-2023-xA suspected case of Clostridium perfringens sepsis with intravascular hemolysis after transhepatic arterial chemoembolization: a case reportHaruki Uojima0Mie Onoue1Hisashi Hidaka2Naohisa Wada3Yoshiaki Tanaka4Tomoyoshi Inoue5Kousuke Kubota6Takahide Nakazawa7Akitaka Shibuya8Wasaburo Koizumi9Department of Gastroenterology, Shonan Kamakura General HospitalDepartment of Gastroenterology, Internal Medicine, Kitasato University School of MedicineDepartment of Gastroenterology, Internal Medicine, Kitasato University School of MedicineDepartment of Gastroenterology, Internal Medicine, Kitasato University School of MedicineDepartment of Gastroenterology, Internal Medicine, Kitasato University School of MedicineDepartment of Gastroenterology, Internal Medicine, Kitasato University School of MedicineDepartment of Gastroenterology, Internal Medicine, Kitasato University School of MedicineDepartment of Gastroenterology, Internal Medicine, Kitasato University School of MedicineDepartment of Gastroenterology, Internal Medicine, Kitasato University School of MedicineDepartment of Gastroenterology, Internal Medicine, Kitasato University School of MedicineAbstract Introduction Sepsis due to Clostridium perfringens, one of several clostridial species, is an important cause of massive intravascular hemolysis in patients with underlying malignancies. Chronic liver diseases, immunosuppression, and presence of malignancies were risk factors for Clostridium perfringens sepsis. Therefore, Clostridium perfringens sepsis should always be considered in patients presenting with liver damage after chemo-embolic therapy for hepatocellular carcinoma. This case report focuses on findings characteristic of an intravascular hemolysis due to Clostridium perfringens after transhepatic arterial chemoembolization. Case presentation An 83-year-old Japanese man presented to our hospital because of a third recurrence of hepatocellular carcinoma. He had nonalcoholic steatohepatitis-related cirrhosis, and underwent radiofrequency ablation and transhepatic arterial chemoembolization therapy for hepatocellular carcinoma of S4/S8 and S2. He had a medical history of pancreatic carcinoma and underwent pylorus-preserving pancreaticoduodenectomy approximately 5 years ago. Because follow-up computed tomography showed a recurrence of the hepatocellular carcinoma, he underwent transhepatic arterial chemoembolization with a hepatic arterial infusion of 20 mg epirubicin, followed by 4 mL Lipiodol (ethiodized oil). On the sixth day after the procedure, he complained of fever and hematuria with jaundice. Laboratory findings indicated hemolysis and increased inflammatory response. Although we initiated antibiotic therapy combined with surgical debridement for infection after transhepatic arterial chemoembolization, he died within 6 hours. The autopsy showed a 4-cm local necrotic hepatic tumor. The cut surface revealed a tumor with an internal spongiform appearance, which was a pseudocystic and partially necrotic lesion. In addition, a diffuse spread of Gram-positive rods in multiple organs including the heart was histologically confirmed. The culture obtained by fluid aspiration from the hepatic abscess revealed Clostridium perfringens. Although the role of Clostridium perfringens was never established during the life of this patient, based on the clinical course and the culture from the hepatic abscess at postmortem, intravascular hemolysis secondary to Clostridium perfringens sepsis was suspected. Conclusion Intravascular hemolysis secondary to Clostridium perfringens should always be considered in patients presenting with liver damage after chemo-embolic therapy for hepatocellular carcinoma. Biliary reconstruction is an especially important risk factor for infection.http://link.springer.com/article/10.1186/s13256-019-2023-xIntravascular hemolysisClostridium perfringensTranshepatic arterial chemoembolization |
| spellingShingle | Haruki Uojima Mie Onoue Hisashi Hidaka Naohisa Wada Yoshiaki Tanaka Tomoyoshi Inoue Kousuke Kubota Takahide Nakazawa Akitaka Shibuya Wasaburo Koizumi A suspected case of Clostridium perfringens sepsis with intravascular hemolysis after transhepatic arterial chemoembolization: a case report Journal of Medical Case Reports Intravascular hemolysis Clostridium perfringens Transhepatic arterial chemoembolization |
| title | A suspected case of Clostridium perfringens sepsis with intravascular hemolysis after transhepatic arterial chemoembolization: a case report |
| title_full | A suspected case of Clostridium perfringens sepsis with intravascular hemolysis after transhepatic arterial chemoembolization: a case report |
| title_fullStr | A suspected case of Clostridium perfringens sepsis with intravascular hemolysis after transhepatic arterial chemoembolization: a case report |
| title_full_unstemmed | A suspected case of Clostridium perfringens sepsis with intravascular hemolysis after transhepatic arterial chemoembolization: a case report |
| title_short | A suspected case of Clostridium perfringens sepsis with intravascular hemolysis after transhepatic arterial chemoembolization: a case report |
| title_sort | suspected case of clostridium perfringens sepsis with intravascular hemolysis after transhepatic arterial chemoembolization a case report |
| topic | Intravascular hemolysis Clostridium perfringens Transhepatic arterial chemoembolization |
| url | http://link.springer.com/article/10.1186/s13256-019-2023-x |
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