Fatal liver abscess caused by Clostridium perfringens complicated with transarterial chemoembolization

Noriaki Sakamoto, Masato Yamaguchi, Takuya Okada, Koji Idoguchi, Eisuke Ueshima, Akhmadu Muradi, Koji Sugimoto

Department of Radiology and Center for Endovascular Therapy, Kobe University Hospital, Kobe City, Japan.

DOI: 10.4236/jbise.2012.512A095                

Abstract

A 77-year-old man who received transarterial chemoembolization for large hepatocellular carcinomas complained of acute pain in the upper abdomen and suddenly developed severe jaundice, anemia, and massive hematuria. Abdominal computed tomography demonstrated gas gangrene at the tumor site. Clostridium perfringens was identified from blood samples and drainage cultures from the liver abscess. Despite intensive treatment, the patient died 55 hours after chemoembolization due to multiple organ failure. When treating patients with large tumors, such as in our case, this rare but fatal complication that causes sepsis and hemolysis with lightning-like rapidity should be considered.

Keywords

Liver; Hepatocellular Carcinoma; Transarterial Chemoembolization; Clostridium perfringens

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Yamada, R., Sato, M., Kawabata, M., et al. (1983) Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology, 148, 397-401．
[2]	Sakamoto, N., Monzawa, S., Nagano, H., et al. (2007) Acute tumor lysis syndrome caused by transcatheter oily chemoembolization in a patient with a large hepatocellular carcinoma. Cardiovascular and Interventional Radiology, 30, 508-511. doi:10.1007/s00270-005-0240-8
[3]	Song, S.Y., Chung, J.W., Han, J.K., et al. (2001) Liver abscess after transcatheter oily chemoembolization for hepatic tumors: Incidence, predisposing factors, and clinical outcome. Journal of Vascular and Interventional Radiology, 12, 313-320. doi:10.1016/S1051-0443(07)61910-1
[4]	van Bunderen, C.C., Bomers, M.K., Wesdorp, E., et al. (2010) Clostridium perfringens septicemia with massive intravascular haemolysis: A case report and review of the literature. Netherlands Journal of Medicine, 68, 343-346.
[5]	Gerson, L.B., Pont, A. and Cummins, R.T. (1994) Clostridial bacteremia and death following chemoembolization for hepatocellular carcinoma. Journal of Vascular and Interventional Radiology, 5, 167-170. doi:10.1016/S1051-0443(94)71477-9
[6]	de Baere, T., Roche, A., Amenabar, J.M., et al. (1996) Liver abscess formation after local treatment of liver tumors. Hepatology, 23, 1436-1440. doi:10.1002/hep.510230620
[7]	Eckel, F., Lersch, C., Huber, W., et al. (2000) Multimicrobial sepsis including Clostridium perfringens after chemoembolization of a single liver metastasis from common bile duct cancer. Digestion, 62, 208-212. doi:10.1159/000007815
[8]	Shim, J.H., Park, J.W., Choi, J.I., et al. (2009) Does postembolization fever after chemoembolization have prognostic significance for survival in patients with unresectable hepatocellular carcinoma? Journal of Vascular and Interventional Radiology, 20, 209-216. doi:10.1016/j.jvir.2008.10.021