Chronic mucoid Pseudomonas aeruginosa cholangitis complicating ERCP in a CF patient.
We report a case of P. aeruginosa cholangitis in an adult with cystic fibrosis (CF). The patient had a past history of cholecystectomy and a new finding of intrahepatic biliary duct stricture. Evaluation and treatment with endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous biliary tract drainage was complicated by post-procedure pain and fever. The only organism recovered from biliary drainage was P. aeruginosa. Southern blot analysis of respiratory and biliary cultures confirmed that the isolates were identical. Despite aggressive antibiotic therapy and drainage, persistent cholangitis and infection have not been eradicated after 6 months. The most likely mechanism of infection of the biliary tract was direct introduction of the upper respiratory tract pathogen during the diagnostic procedure.
Wallick
Kristin
K
University of Colorado Health Sciences Center, Denver, CO, USA. kristin.wallick@uchsc.edu
Dickinson
Matthew
M
James
David S
DS
Kugelmas
Marcelo
M
Madinger
Nancy
N
Rodman
David
D
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001649:Bile Duct Diseases / Q000209:etiology / Q000628:therapy; D001653:Bile Ducts, Intrahepatic; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D002761:Cholangitis / Q000188:drug therapy / Q000382:microbiology*; D002908:Chronic Disease; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D003550:Cystic Fibrosis / Q000188:drug therapy / Q000382:microbiology*; D004322:Drainage / Q000009:adverse effects; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000382:microbiology*; D017211:Treatment Failure
D000900:Anti-Bacterial Agents