[Yersinia enterocolitica infection with extraintestinal manifestations: case report and overview]

Z Gastroenterol. 1994 Mar;32(3):152-6.
[Article in German]

Abstract

Five weeks after a four-day visit to Malta, a 39-year old white male German national developed septic temperatures of up to 40 degrees C, progressive jaundice and a pronounced hepatosplenomegaly. The initial examination showed a very sick, somnolent patient with jaundice, cyanosis, tachypnea and a markedly enlarged liver on both physical examination and sonography. The laboratory evaluation revealed a moderate leukocytosis, markedly accelerated ESR, poor liver function with strongly elevated gamma-GT and alkaline phosphatase levels. Primary antibiotic therapy consisted of doxycycline. Ultrasound examination of the liver four days after admission revealed multiple hypodense abscesses. On the sixth day after admission, gram-negative rods were first isolated from blood cultures; antibiotic therapy was switched to ofloxacin (2 x 400 mg/day) and amoxycillin (3 x 2 g/day) after sensitivity testing. As a result of treatment with this combination of antibiotics, the patient was free of fever 10 days after hospitalization; on the same day yersinia enterocolitica was isolated from the first blood cultures taken on admission. The diagnosis of non-enteric forms of yersinia infection can prove very difficult, especially if the serology is not clear cut and there are no immunological complications. A presentation including intermittent fever, moderate leukocytosis, strongly accelerated ESR and multiple hypodense abscesses in the liver should lead one to consider a non-enteric type of yersinia infection. Hepatic abscesses usually occur in patients who have an iron overload.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Anti-Bacterial Agents
  • Bacteriological Techniques
  • Diagnosis, Differential
  • Drug Therapy, Combination / therapeutic use
  • Humans
  • Liver Abscess / diagnostic imaging*
  • Liver Abscess / drug therapy
  • Liver Cirrhosis, Alcoholic / complications
  • Liver Cirrhosis, Alcoholic / diagnostic imaging
  • Liver Function Tests
  • Male
  • Malta
  • Sepsis / diagnostic imaging*
  • Sepsis / drug therapy
  • Travel
  • Ultrasonography
  • Yersinia Infections / diagnostic imaging*
  • Yersinia Infections / drug therapy
  • Yersinia enterocolitica*

Substances

  • Anti-Bacterial Agents