RESUMO
Despite advances in immunosuppression and liver transplant in the past, mortality and morbidity caused by infections remain major problems. We present a 71-year-old man who was admitted to our internal intensive care unit with septicemia. Upon admission, he had poorly localized epigastric pain and fever of 2 days ' duration. Twenty years earlier, he had undergone an orthotopic liver transplant. Testing revealed a high C-reactive protein level, elevated liver enzymes, and an acute kidney injury. A computer tomography scan showed 2 circular, non--rim-enhancing, totally emphysematous intrahepatic lesions. Additionally, gas could be seen in the portal veins mainly, as well as in the biliary system, in the right auricle, and the splenic veins. To the best of our knowledge, he showed no malignant lesion or predisposing trauma. Empirically, treatment with broad-spectrum antibiotics was begun, and the patient was transferred to the operating suite. When surgery began, blood cultures revealed the presence of gram-positive bacilli, which were identified as Clostridium perfringens. Seven hours after the surgery, the patient developed asystole and died. In septic patients presenting with severe hemolysis, Clostridium perfringens infection must be considered in the absence of a malignant lesion or a predisposing trauma; a previous episode of gastroenteritis might be a predisposing trauma by impairing the barrier of the intestinal flora, leading to Clostridium perfringens infection.
Assuntos
Clostridium perfringens/patogenicidade , Gangrena Gasosa/microbiologia , Cardiopatias/microbiologia , Abscesso Hepático/microbiologia , Transplante de Fígado/efeitos adversos , Esplenopatias/microbiologia , Idoso , Antibacterianos/uso terapêutico , Evolução Fatal , Gangrena Gasosa/diagnóstico , Gangrena Gasosa/terapia , Cardiopatias/diagnóstico , Cardiopatias/terapia , Humanos , Abscesso Hepático/diagnóstico , Abscesso Hepático/terapia , Masculino , Reoperação , Fatores de Risco , Sepse/diagnóstico , Sepse/microbiologia , Esplenopatias/diagnóstico , Esplenopatias/terapia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We report the case of a 62-year-old woman who initially presented with symptoms suggesting acute type A aortic dissection. Imaging studies revealed hemorrhagic pericardial fluid without the evidence of dissection. Foreign body material was noted floating in the inferior vena cava (IVC) and also piercing the right ventricular wall. Upon surgical exploration, the extracted material could be identified to be acrylic bone cement (palacos). The patient had reported a history of kyphoplasty in 2008.
