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Yersinia Enterocolitica Pneumonia: A Rare Presentation of a Common Organism
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A3586 - Yersinia Enterocolitica Pneumonia: A Rare Presentation of a Common Organism
Author Block: T. M. Dempsey, S. Kalra; Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, United States.
Yersinia enterocolitica is a gram negative bacillus that is one of the most common gastrointestinal pathogens. In immunosuppressed patients, it can lead to extra-intestinal disease including bacteremia, reactive arthritis, and hepatic or splenic abscesses. This case documents a pulmonary infection caused by this bacteria, an exceedingly rare presentation and one that may support the emerging “gut-lung axis” theory.
A 60-year-old immunosuppressed man, with a history of renal transplant, was transferred from an outside hospital with persistent diarrhea. His stool culture was positive for both Clostridium difficile and Yersinia enterocolitica, though on transfer he was only receiving treatment for the C. difficile, with oral vancomycin, due to delay in speciation of the Yersinia.
On review of systems, he reported a cough productive of yellowish sputum and dyspnea on exertion, both of which had started a few days after the diarrhea. He denied any history of lung infections or lung diseases, but was a prior heavy smoker.
He was admitted to our hospital and levofloxacin was initiated to treat the Y. enterocolitica, in addition to continuing oral vancomycin. Blood cultures drawn on transfer returned positive for Y. enterocolitica around the time a chest x-ray showed a new right upper lobe infiltrate. A CT scan to further evaluate the pulmonary infiltrate revealed a focal, dense consolidation in the right upper lobe. Given his immunosuppression, a bronchoscopy with lavage and transbronchial biopsy was performed, with the results of the BAL (and a sputum culture done around the same time) growing Yersinia enterocolitica. The biopsy showed an organizing pneumonia suggestive of infection, though no microorganisms were isolated.
This case demonstrates a rare presentation, in an immunocompromised host, of a common gastrointestinal pathogen, which has previously only been reported in the literature 17 times. In addition to the rarity of this presentation, current hypotheses invoking the “gut-lung axis” in the transmission of such organisms are topics of increasing interest, with case reports of gastrointestinal pathogens infecting the lungs via microbial translocation, as well as ongoing research into disturbances of the microbiome; some animal studies even suggest a reduction in GI pathogen associated pulmonary infections when probiotics are utilized.
This patient was continued on levofloxacin with improvement in his respiratory and gastrointestinal symptoms. He was discharged home after a short hospital stay with a plan for a fourteen-day course of antibiotics.
Author Block: T. M. Dempsey, S. Kalra; Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, United States.
Yersinia enterocolitica is a gram negative bacillus that is one of the most common gastrointestinal pathogens. In immunosuppressed patients, it can lead to extra-intestinal disease including bacteremia, reactive arthritis, and hepatic or splenic abscesses. This case documents a pulmonary infection caused by this bacteria, an exceedingly rare presentation and one that may support the emerging “gut-lung axis” theory.
A 60-year-old immunosuppressed man, with a history of renal transplant, was transferred from an outside hospital with persistent diarrhea. His stool culture was positive for both Clostridium difficile and Yersinia enterocolitica, though on transfer he was only receiving treatment for the C. difficile, with oral vancomycin, due to delay in speciation of the Yersinia.
On review of systems, he reported a cough productive of yellowish sputum and dyspnea on exertion, both of which had started a few days after the diarrhea. He denied any history of lung infections or lung diseases, but was a prior heavy smoker.
He was admitted to our hospital and levofloxacin was initiated to treat the Y. enterocolitica, in addition to continuing oral vancomycin. Blood cultures drawn on transfer returned positive for Y. enterocolitica around the time a chest x-ray showed a new right upper lobe infiltrate. A CT scan to further evaluate the pulmonary infiltrate revealed a focal, dense consolidation in the right upper lobe. Given his immunosuppression, a bronchoscopy with lavage and transbronchial biopsy was performed, with the results of the BAL (and a sputum culture done around the same time) growing Yersinia enterocolitica. The biopsy showed an organizing pneumonia suggestive of infection, though no microorganisms were isolated.
This case demonstrates a rare presentation, in an immunocompromised host, of a common gastrointestinal pathogen, which has previously only been reported in the literature 17 times. In addition to the rarity of this presentation, current hypotheses invoking the “gut-lung axis” in the transmission of such organisms are topics of increasing interest, with case reports of gastrointestinal pathogens infecting the lungs via microbial translocation, as well as ongoing research into disturbances of the microbiome; some animal studies even suggest a reduction in GI pathogen associated pulmonary infections when probiotics are utilized.
This patient was continued on levofloxacin with improvement in his respiratory and gastrointestinal symptoms. He was discharged home after a short hospital stay with a plan for a fourteen-day course of antibiotics.
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