Via Research Recognition Day Program VCOM-Carolinas 2025

Case Reports

Extra-Intestinal Manifestation of Yersinia Enterolitica without Gastrointestinal Symptoms

Morgan Minner, OMS-III, Stanley Miller, MD. Edward Via College of Osteopathic Medicine - Carolinas, Spartanburg, SC.

Background

Discussion

Case Report

A 61-year-old male with a history of hypertension, hyperlipidemia, and prostate adenocarcinoma in remission presented to his primary care physician with complaints of fevers, night sweats, fatigue, and loss of appetite for 2 weeks duration. He denied any acute gastrointestinal symptoms. Labs were only remarkable for leukocytosis. Amoxicillin/clavulanate was prescribed for management of an ‘infection of unknown source’. Blood cultures were negative. A CT scan demonstrated multiple liver lesions concerning for abscesses versus malignancy.

Yersinia enterolitica commonly presents as an acute GI illness with recognizable symptoms. Y. enterocolitica is an iron-utilizing microorganism. Multiple case reports of liver abscesses due to Y. enterocolitica are found to be in patients with underlying primary hemochromatosis 5 . Surprisingly, this patient had no evidence of a preexisting hemochromatosis such as elevated serum iron or ferritin. Extraintestinal manifestations of Y. enterocolitica are uncommon, with hepatic abscess formation representing an exceedingly rare occurrence.

First described by Sten Winblad in 1966, Yersinia enterocolitica is a gram-negative bacillus that primarily causes acute gastrointestinal illness and sepsis 1 . Yersiniosis often mimics appendicitis, presenting with fever, leukocytosis, and left lower quadrant pain. Transmission occurs via fecal-oral route, with undercooked pork being a common source. The pathogen invades lymphoid tissue after penetrating the gastrointestinal mucosa, facilitating spread into other organs. Diagnosis requires stool cultures, as blood tests are typically unremarkable. Management involves supportive care along with antibiotics, such as aminoglycosides , trimethoprim sulfamethoxazole , tetracyclines , fluoroquinolones , or cephalosporins 2 . Liver abscesses are common visceral abscesses often arising from underlying biliary disease , hematogenous spread , direct bowel leakage into the portal vein, appendicitis, or cholangitis. They typically involve polymicrobial infections, including E. coli, Staphylococcus, anaerobes , and protozoan such as Entamoeba histolytica.

Figure 1. First CT scan performed in the outpatient setting. Shows development of numerous liver lesions concerning for metastatic disease versus multifocal hepatic abscesses.

Figure 2. CT scan 2 months later revealing an overall decrease in conspicuity of numerous hepatic lesions. Findings represent resolving hepatic abscesses.

Conclusions A case of asymptomatic liver abscesses caused by Y. enterocolitica was successfully treated with ceftriaxone (later switched to levofloxacin) and metronidazole for a total of 8 weeks of antibiotic therapy. Future research considerations in this case include a greater understanding of the mechanisms by which Y. enterocolitica can precipitate liver abscesses in the absence of underlying hematologic spread, biliary disease, or hemochromatosis.

The patient was admitted to the hospital for lesion sampling and source control. Cefepime and vancomycin were empirically given but the regimen was soon switched to ceftriaxone and metronidazole due to better empiric coverage. An ultrasound-guided fine-needle aspiration biopsy was performed, and abscesses described as grossly foul-smelling and viscous. The culture grew Yersinia enterocolitica sensitive to ceftriaxone . Infectious Disease (ID) was consulted due to the nature and rarity of this case. Throughout the hospital course the patient remained afebrile, and his fatigue and night sweats resolved. He was discharged on hospital day 7 with oral metronidazole and IV ceftriaxone via PICC line. He followed up with ID in the outpatient setting, and serial CT scans revealed continued resolution of the abscesses. Due to significant improvement, his PICC line was removed after 4 weeks and antibiotic regimen changed to oral levofloxacin and metronidazole for an additional 4 weeks to complete antibiotic therapy. He has had no recurrence of the abscesses in follow up.

Figure 1. A field of numerous Gram negative, rod shaped, Yersinia enterocolitica bacteria, the cause of yersiniosis in humans, as well as many animals.

Figure 2. A photograph showing the typical “safety - pin” – like structure of Y. enterocolitica.

Typical symptoms of liver abscesses include fever , right upper quadrant pain , chills , and weight loss . On physical exam, hepatomegaly and jaundice may be present. Abdominal CT scans remain the most sensitive diagnostic tool. Prognosis is favorable due to improved drainage techniques and targeted antibiotic therapy, with in-hospital mortality ranging from 2.5% to 19% 3 .

References

1. Winblad S, Niléhn B, Sternby NH. Yersinia enterocolitica (Pasteurella x) in human enteric infections. Br Med J. 1966;2(5526):1363-1366. doi:10.1136/bmj.2.5526.1363 2. Aziz M, Yelamanchili VS. Yersinia Enterocolitica. In: StatPearls. StatPearls Publishing; 2024. 3. Akhondi H, Sabih DE. Liver Abscess. In: StatPearls. StatPearls Publishing; 2024. 4. Aziz M, Yelamanchili VS. Yersinia Enterocolitica. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. [Figure, Gram stain-yersinia Image courtesy O.Chaigasame]Available from: https://www.ncbi.nlm.nih.gov/books/NBK499837/figure/article-31453.image.f1/ 5. Meyers, Michael MD; Spoolstra, Mark MD. S2901 Yersinia enterocolitica Liver Abscesses as an Atypical Presentation of Hereditary Hemochromatosis. The American Journal of Gastroenterology 116():p S1202, October 2021. | DOI: 10.14309/01.ajg.0000785136.85129.e3

2025 Research Recognition Day

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