SHM Converge Scientific Abstract ePoster Gallery-Emphysematous Hepatitis in an Immunocompromised Patient: A Rare and Fatal Diagnostic Challenge

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This case describes a 73-year-old immunocompromised man with HIV/AIDS and MBL vs CLL who presented to the emergency department with sudden abdominal distention, dyspnea, fever, poor appetite, tachycardia, tachypnea, borderline hypotension, and hypoxia. Initial labs showed severe sepsis with elevated lactate, marked transaminitis, hyperbilirubinemia, and a very high lipase. Imaging revealed multiple liver microabscesses with emphysematous changes and gallbladder wall thickening, raising concern for emphysematous hepatitis with possible biliary involvement.<br /><br />The patient was started on broad-spectrum antibiotics (Zosyn), resuscitated, and admitted to the ICU for septic shock. Blood cultures grew Escherichia coli and Klebsiella pneumoniae. His HIV was profoundly uncontrolled with a CD4 count of 5 despite an undetectable viral load. Multiple services were consulted: surgery deferred cholecystectomy because of instability, gastroenterology deferred ERCP, and interventional radiology found the abscesses too small for drainage. A percutaneous biliary drain was placed, with possible cholecystectomy planned if he stabilized.<br /><br />Despite aggressive care, the patient’s condition rapidly worsened, progressing to respiratory failure, refractory hypotension requiring three vasopressors, and eventual asystole. He chose DNR/DNI status and died with his partner at bedside.<br /><br />The report emphasizes that emphysematous hepatitis is extremely rare, difficult to diagnose early because of nonspecific symptoms, and highly fatal. Risk factors include diabetes, immunosuppression, and polymicrobial infection. CT imaging is crucial for diagnosis, and treatment typically requires urgent broad-spectrum antimicrobials plus early specialist and often surgical intervention, though no standardized protocol exists. Approximately 20 cases have been reported, with only a few successful outcomes.

Asset Subtitle

Krystal Hirayama

Meta Tag

Author List Audrey Shawley, Krystal Hirayama, Laya Reddy

Category Clinical Vignettes

Concept Emphysematous Hepatitis

Concept Computed Tomography

Concept Gas in Liver

Concept Hepatic Infection

Concept Immunosuppression

Distinguished Non-Finalist

Presenter Organization Scripps Mercy Hospital San Diego

Presenting Author Krystal Hirayama

Track Adult

Keywords

emphysematous hepatitis

septic shock

HIV/AIDS

immunocompromised

liver microabscesses

Escherichia coli

Klebsiella pneumoniae

biliary drain

CT imaging

respiratory failure

Emphysematous Hepatitis

Computed Tomography

Gas in Liver

Hepatic Infection

Immunosuppression