Emphysematous hepatitis

Last revised by Dr Bahman Rasuli on 08 Jan 2021

Emphysematous hepatitis is a very rare condition characterized by a gas-forming infection of the liver, which in all reported cases has been rapidly fatal. Diabetes mellitus commonly coexists. 

Emphysematous hepatitis is extremely rare, with less than 10 reported cases in the literature 1-8. Many cases - not all - have pre-existing diabetes mellitus. Ages affected have been 43 to 80 years and it has been seen in both sexes. All eight reported cases have been fatal.

Most of the published cases present with right upper quadrant pain, leukocytosis and raised inflammatory markers.

Sepsis is common at presentation, and universal soon thereafter. Pneumoperitoneum was seen in one case on presentation 8.

A variety of bacteria have been grown in cultures of liver and blood samples, namely Klebsiella pneumoniae, Clostridium perfringens, Escherichia coli, Enterobacter cloacae, Streptococcus mutans and Enterococcus faecalis 1,3,8.

The cardinal feature of this presentation is extensive gas replacing the normal hepatic parenchyma without mass effect or any fluid collection. In all reported cases, the portal and hepatic veins have remained patent with no intravenous gas.

The findings have been reported on plain radiograph 6, CT 1-8 and ultrasound 2

Attempts are usually made to drain the gas on the concern of an underlying collection but usually, no fluid/pus is obtained.

All reported cases have succumbed to the disease within three days of admission 1-8, one within 13 hours 3.

The first reported case of emphysematous hepatitis was in 2002 by Arye Blachar and colleagues, at that time a radiologist at the University of Pittsburgh, now in Tel Aviv, Israel (fl. 2020) 4.

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