Fulminant Emphysematous Hepatitis – A Rare Cause of Septic S
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Emphysematous hepatitis is a rare condition characterized by the replacement of hepatic parenchyma by gas. The diagnosis of emphysematous hepatitis requires imaging, preferably a computed tomography scan. Emphysematous hepatitis warrants awareness among clinicians for early diagnosis and rapid and aggressive management.

A 74-year-old man was admitted to the emergency department (ED) of our hospital with altered mental status. He complained of fever, cough with mucopurulent sputum, and abdominal pain for 2 days. He had a medical history of hypertension, gastroesophageal reflux, and moderate alcohol consumption. His usual medication was lansoprazole 20 mg daily, perindopril 5 mg daily, and amlodipine 5 mg daily, with no known medical allergies.

On examination, he was disoriented and uncooperative. His vital signs included blood pressure of 135/85 mmHg, heart rate of 103 beats/min, respiratory frequency of 18 breaths/min, peripheral oxygen saturation of 85% on room air, and tympanic temperature of 39.6 ºC. His skin showed signs of livedo reticularis and his capillary refill time was increased. Pulmonary auscultation showed bilateral rhonchi. On abdominal palpation, he complained of intense epigastric and right hypochondrium pain with muscle guarding. Laboratory examination revealed hypoxic respiratory failure, leukocytosis with neutrophilia, and a significantly altered liver profile: aspartate aminotransferase 1896 U/L; alanine aminotransferase 640 U/L; lactate dehydrogenase 2499 U/L; alkaline phosphatase 230 U/L; total bilirubin 4.78 mg/dL.

On the second day of admission, his clinical state deteriorated along with blood analysis; the antimicrobial spectrum was extended and he was commenced on vancomycin, metronidazole, and fluconazole. Despite these measures, his condition evolved to multiorgan failure and he died on the third day of admission. The decision for autopsy was deterred due to a lack of consent. Blood cultures subsequently grew multi-sensitive Escherichia coli.

Emphysematous hepatitis continues to be difficult to manage and despite aggressive measures the condition progresses to a fatal outcome in the first days of admission, as seen in our case and other reported cases. We encourage the use of aggressive early therapeutic measures in patients with emphysematous hepatitis in order to control the infection.

Source: https://www.ejcrim.com/index.php/EJCRIM/article/view/1539/2013