title: [Yersinia enterocolitica infection with extraintestinal manifestations: case report and overview].
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.
authors.affiliation: Abteilung Innere Medizin, PIUS-Hospital Oldenburg.
authors.forename: P
authors.initials: P
authors.lastname: Janowitz
authors.forename: J G
authors.initials: JG
authors.lastname: Wechsler
authors.forename: P
authors.initials: P
authors.lastname: Malfertheiner
authors.forename: J
authors.initials: J
authors.lastname: Blanco
authors.forename: P
authors.initials: P
authors.lastname: Kern
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents; D001431:Bacteriological Techniques; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006801:Humans; D008100:Liver Abscess / Q000000981:diagnostic imaging* / Q000188:drug therapy; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000000981:diagnostic imaging; D008111:Liver Function Tests; D008297:Male; D008319:Malta; D018805:Sepsis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D014195:Travel; D014463:Ultrasonography; D015009:Yersinia Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015008:Yersinia enterocolitica
chemical_list: D000900:Anti-Bacterial Agents
vernacular_title: Yersinia-enterocolitica-Infektion mit extraintestinaler Manifestation: Fallbericht und Ubersicht.