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58

FULMINANT SEPTIC SCOCK DUE TO CLOSTREDIUM PERFIGENS SOFT AND SKIN TISSUE INFECTION EIGHT YEARS AFTER LIVER TRANSPLANTATION

Thursday, 25 November, 2010 - 08:50
Group 3 - 1

Εισαγωγή

  • Liver transplanted patients are at risk of infection development.
  • The main cause of death during the first year after liver transplant are actually bacterial and fungal infections.
  • The gas gangrene caused by Clostridium perfringens consists a severe form of wound infection.
  • Despite optimal therapy, the mortality rises 40-60%. Up to 120 cases are yearly in Germany registered. Thus, it represents a rather rare infectious disease.
  • We report about a patient who developed Clostridium perfringens infection of the right knee eight years after liver transplantation.

Full Text

Introduction

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Liver transplanted patients are at risk of infection development.

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The main cause of death during the first year after liver transplant are actually bacterial and fungal infections.

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The gas gangrene caused by Clostridium perfringens consists a severe form of wound infection.

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Despite optimal therapy, the mortality rises 40-60%. Up to 120 cases are yearly in Germany registered. Thus, it represents a rather rare infectious disease.

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We report about a patient who developed Clostridium perfringens infection of the right knee eight years after liver transplantation.
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Patient

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55-year-old patient

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State after Liver Transplantation 2001 due to cryptogenic liver cirrhosis

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Re-listing for liver transplantation due to graft-cirrhosis

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IDDM

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s.c. Insulin injection predominantly on the inside of the right thigh, above the knee

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Immunsupression therapy: tacrolimus (target levels 4-6 ng / ml), mycophenolate mofetil 2 g / day, no steroids.
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images/Cl1.jpg

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Figure 1. X-ray of the lower extremities with typical muscle feathering of gas gangrene
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images/Cl2.jpg

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Figure 2 CT of the lower extremities with gas-filled soft tissue due to infection with Clostridium perfringens
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Clinical Course

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Hospitalisation due to since 3 days increasing tumor of the right knee

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Crepitus was triggered during the last 24 hours

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Chemical laboratory signs of inflammation: leukocytes 15.1 / nl, CRP 5.6 mg / dl; procalcitonin 11.99 ng / ml

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Prompt surgical debridement + supplementation antibiotic therapy (imipenem / Cilastation + clindamycin)

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Intra-operative septic shock with severe coagulopathy and massive transfusion

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Postoperative septic shock and multiple organ failure

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The patient died six hours after surgery

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Postmortem microbiological detection of Clostridium perfringens.

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Conclusion

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This case describes a fulminant and lethal course of gas gangrene infection 8 years after liver transplantation.
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In suspicion of a gas gangrene immediate surgical debridement with concommitant antibiotic therapy are absolutely indicated.
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Delay of treatment may be fatal
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Despite its rarity, Clostridium perfringens infection should also be taken into account in septic complications of transplanted patients

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