Severe acute liver injury associated withYersinia enterocolitica

Abstract

Yersinia enterocolitica is a Gram-negative bacterium that causes foodborne illnesses, typically characterised by acute febrile gastroenteritis and is associated with a variety of manifestations. Isolated febrile illness without gastrointestinal symptoms is rare. We report a case of Y. enterocolitica infection with severe anicteric hepatitis. A 33-year-old Chinese man with no significant medical history presented on multiple occasions to the emergency department with recurrent high-grade fever and chills, but without gastrointestinal symptoms. Hepatic panel showed rising transaminases that peaked at Aspartate Aminotransferase (AST) of 991 U/L and Alanine Aminotransferase (ALT) of 1664 U/L. CT of the abdomen revealed terminal ileitis and mesenteric adenitis. As part of workup, we found positive serology for Y. enterocolitica. Ultimately, he improved with supportive care. This case highlights the importance of thorough workup of terminal ileitis and ‘Crohn’s mimics’ which ultimately revealed a unifying diagnosis; and an important addition to the workup for undifferentiated severe isolated hepatocellular liver injury.

Yersinia enterocolitica in Crohn’s disease

“…After the incubation period of 4–7 days, the engulfed bacteria migrate to the mesenteric lymph nodes, where they multiply and cause abscess formation ( Hein et al., 2000 ). Systemic infection occurs with the migration of Y. enterocolitica along with the lymphatic fluid or blood and may cause extraintestinal complications, such as sepsis ( Lai et al., 2014 ), deep organ abscess ( Viteri et al., 1981 ; Demes et al., 2021 ), and arthritis ( Appel et al., 2002 ). Moreover, YadA-mediated complement evasion may result in persistent pathogen presence ( China et al., 1993 ).…”