Yersinia pseudotuberculosis is a gram-negative bacillus from the family of Yersiniacae. Similar to the other member of the family, Yersinia enterocolitica, Y. pseudotuberculosis most commonly presents with enteric illness [1]. The sources of infection with Y. pseudotuberculosis include contaminated food such as dairy and vegetables or contaminated water [2]. Direct contact with animals including dogs, rodents, rabbits, farm animals or birds has also been described as other modes of acquisition [1,2]. Community outbreaks secondary to contaminated lettuce, carrots, and water have been reported in Finland, Japan, Russia and Canada [3,4]. Although it often presents as mild gastroenteritis, several other clinical manifestations have been reported with Y. pseudotuberculosis [1]. Pseudoappendicitis with mesenteric lymphadenitis is a well described phenomenon and many patients in the 20th century underwent appendectomies due to erroneous diagnosis after presenting with right lower quadrant abdominal pain [5]. Bacteremia is rare and when it occurs it has been associated with abscesses in spleen, liver, kidneys, lung with granulomatous appearance that mimics tuberculosis [5,6]. Although it is commonly a self-limiting illness in immunocompetent patients without liver disease, septicemia with Y. pseudotuberculosis is thought to carry a fatality rate that exceeds 75% without antibiotics [2]. Here we present a case of Yersinia pseudotuberculosis bacteremia with splenic abscesses in a patient with previously undiagnosed liver cirrhosis.
Introduction: Yersinia pseudotuberculosis has been known to cause a variety of clinical manifestations ranging from mild enteric illness to bacteremia with septic shock and extraintestinal abscesses. Patients with liver disease and iron overload are at risk of more severe disease manifestations. Case Report: A middle aged male with chronic alcohol use disorder presented with confusion and jaundice with ascites and asterixis noted on exam. His blood work was remarkable for neutrophilic leukocytosis, elevated liver enzymes and lactate. His abdominal CT revealed splenic microabscesses and a cirrhotic liver. Yersinia pseudotuberculosis was recovered from his blood cultures and he was treated with ceftriaxone following susceptibility results. Conclusion: Y. pseudotuberculosis should be considered in the differential diagnosis of splenic or other extraintestinal microabscesses particularly in patients with chronic liver disease.
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