Liver abscess and splenic infarction due to Yersinia pseudotuberculosis bloodstream infection: a case report

Background: Yersinia pseudotuberculosis is an emerging zoonotic intestinal pathogen primarily transmitted through contaminated food and water. Infections caused by Yersinia pseudotuberculosis are typically self-limiting, often presenting as gastroenteritis or "pseudoappendicitis," which is characterized by fever and abdominal pain. Although bloodstream infections with Yersinia pseudotuberculosis are rare, they can lead to multiple distant sites of infection, including abscesses in the liver, spleen, and kidneys, as well as in the hip and knee joints, particularly in individuals with underlying immunodeficiency.

Case presentation: We report the case of a 40-year-old male patient who was admitted to the intensive care unit (ICU) with intermittent fever lasting for five days, followed by exacerbation of abdominal pain and distension one day after ingesting contaminated food. Upon admission, the patient exhibited severe hypotension, which rapidly progressed to signs of liver and kidney failure, ultimately leading to multiple organ dysfunction syndrome (MODS). Notably, abdominal computed tomography (CT) revealed evidence of a liver abscess and splenic infarction. The treatment regimen included fluid resuscitation, broad-spectrum antibiotics, vasopressors, continuous renal replacement therapy (CRRT), and plasma exchange. Blood cultures along with metagenomic next-generation sequencing (mNGS) confirmed an infection caused by Yersinia pseudotuberculosis. After 17 days in the ICU, the patient was transferred to the infectious disease department for an additional 14 days of treatment before being discharged. Three months post-discharge, follow-up visits indicated that the patient was in good health.

Conclusions: To the best of our knowledge, this case represents a rare instance of multiple organ dysfunction syndrome (MODS), liver abscess, and splenic infarction resulting from Yersinia pseudotuberculosis infection. The identification of the pathogen was facilitated by blood culture and metagenomic next-generation sequencing (mNGS) of blood samples. The administration of broad-spectrum antibiotics, along with active support for organ function, ultimately contributed to the patient's recovery.

Clinical trial number: No applicable.