Fulminant emphysematous hepatitis with massive intravascular haemolysis due to Clostridium perfringens infection.

Clostridium perfringens is an anaerobic spore-forming bacterium capable of producing fulminant infections through potent exotoxins. We report the case of an elderly man with multiple comorbidities who presented with acute abdominal pain and vomiting. Within 24 hours, the patient developed abrupt clinical deterioration characterised by altered mental status, rapidly progressive anaemia, metabolic acidosis and multiorgan dysfunction. A CT scan demonstrated multiple gas-containing hepatic lesions without a well-defined fluid collection, compatible with emphysematous hepatitis. Blood cultures rapidly confirmed C. perfringens Despite prompt escalation of antimicrobial therapy and intensive supportive management, the patient developed progressive multiorgan failure and died 96 hours after admission. Although C. perfringens liver abscesses associated with haemolysis have been previously described, reports combining fulminant haemolysis with a radiological pattern consistent with emphysematous hepatitis remain exceedingly rare. This case highlights the importance of early recognition of this catastrophic presentation and the need for immediate antimicrobial therapy and source control whenever feasible.