title: Lactobacillus fermentum, a pathogen in documented cholecystitis.
abstract: BACKGROUND
  Lactobacillus species are probiotics proven to exhibit various preventative as well as therapeutic properties. While lactobacillus species have been implicated in the formation of dental caries, endocarditis and bacteremia, their role as pathogens in cholecystitis has not been reported. We present a rare case of Lactobacillus fermentum working as a pathogen in cholecystitis.
  
  
  METHODS
  An 81-year old male was admitted with right upper quadrant abdominal pain. His signs, symptoms, laboratory values and imaging were consistent with a diagnosis of cholecystitis with ascending cholangitis. In view of his co-morbidity and severe sepsis, the patient was treated non-operatively with antibiotics and cholecystostomy. L. fermentum, which was vancomycin resistant, was identified from the cholecystostomy aspirate and from anaerobic blood culture. The patient went into septic shock, developed multi-organ dysfunction syndrome and eventually died.
  
  
  CONCLUSIONS
  Commensal bacteria such as L. fermentum are known to modulate immunity, reduce the pathogenicity of gastrointestinal organisms and play a therapeutic role in various disease processes. We isolated L. fermentum as a pathogen in a documented case of cholecystitis with ascending cholangitis.
  
  
  CONCLUSIONS
  While the routine use lactobacillus species as a probiotic is supported in the literature, understanding its potential role as a pathogen may allow more judicious use of these bacteria and encourage research to elucidate the pathogenicity of lactobacillus species.
authors.affiliation: Department of Surgery, New York Methodist Hospital, Brooklyn, NY, United States. Electronic address: jchery03@yahoo.com.
authors.forename: Josue
authors.initials: J
authors.lastname: Chery
authors.forename: Dmitriy
authors.initials: D
authors.lastname: Dvoskin
authors.forename: Fernando P
authors.initials: FP
authors.lastname: Morato
authors.forename: Bashar
authors.initials: B
authors.lastname: Fahoum
keywords: Cholangitis; Cholecystitis; Lactobacillus; Multi-organ dysfunction syndrome; Pathogenicity; Probiotic