Extraintestinal Manifestation of Yersinia pseudotuberculosis Bacteremia as Acute Hepatitis: Case Report and Review of the Literature

Abstract

Yersinia pseudotuberculosis is a causative agent of foodborne zoonosis that usually causes self-limiting pseudoappendicitis. Y. pseudotuberculosis infection also causes systemic spread or extraintestinal manifestations in patients with predisposing conditions. Here, we present a case of acute hepatitis with Y. pseudotuberculosis bacteremia in a 30-year-old man. He was previously healthy without significant medical history other than obesity and current smoking. At the time of admission, he presented with high fever accompanied by chills, jaundice, abdominal pain, and watery diarrhea. Laboratory studies revealed leukocytosis and elevated liver function parameters. A stool culture showed no causative pathogens. Empiric antibiotic therapy with ceftriaxone and metronidazole was administered. Y. pseudotuberculosis was later isolated from the initial blood culture performed on the day of admission using MALDI-TOF mass spectrometry. Antibiotic treatment was continued based on the susceptibility testing results from MALDI-TOF MS and VITEk®2, as well as clinical and laboratory improvements. The patient was discharged on the tenth day of admission and remained healthy with no recurrence during the 12-month follow-up. Here, we review the literature on the systemic infection caused by Y. pseudotuberculosis, including extraintestinal manifestations. This case highlights that Y. pseudotuberculosis may be considered a differential causative organism in patients with acute colitis and hepatitis.

Risk factors matter: case report of <I>Y. pseudotuberculosis</I> in obese patient

“…In 4 of the 12 reported cases, the patients had no underlying diseases; in the remaining cases, people presented comorbidity and risk factors such as smoke, obesity and diabetes. Fever with gastrointestinal symptoms was the most common, three cases only presented extraintestinal symptoms (7).…”

“…According to a report in 2010 ( 5), a high proportion of Y. pseudotuberculosis cases have been diagnosed by blood culture, suggesting that underdiagnoses of less invasive Y. pseudotuberculosis infections may explain the rarity of its incidence. Furthermore, the fact that this bacterium and its natural history are very unfamiliar to physicians makes the clinical diagnosis more difficult (7).…”

“…Lee et al ( 2021) reviewed literature, between 2000 and 2021, and found that were reported only a few cases of bacteraemia caused by Y. pseudotuberculosis 7 . In 4 of the 12 reported cases, the patients had no underlying diseases; in the remaining cases, people presented comorbidity and risk factors such as smoke, obesity and diabetes.…”

Recent Advances in Nanozyme-Mediated Strategies for Pathogen Detection and Control

“…Yersinia pseudotuberculosis, a food and waterborne bacterium, is primarily transmitted among humans through the fecal-oral route, resulting in the development of yersiniosis [99][100][101]. Reactive arthritis, Reiter's syndrome, erythema nodosum, glomerulonephritis, myocarditis, and sepsis are among the notable complications that can arise from Yersinia pseudotuberculosis infection [102].…”

Yersinia pseudotuberculosis bacteraemia with splenic abscesses: a case report

“…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]. Bacteraemia is rare and when it occurs it has been associated with abscesses in the spleen, liver, kidneys and lung with a granulomatous appearance that mimics tuberculosis [5, 6]. Although it is commonly a self-limiting illness in immunocompetent patients, septicaemia with Y.…”