title: Hepatitis From Spiroplasma sp. in an Immunocompromised Patient.
abstract: A 70-year-old lung transplant recipient patient was admitted with fever, nausea, abdominal pain, peripheral edema and pronounced weakness. An initial work-up for presumed infection revealed cholestatic hepatitis, leukocytosis and thrombocytopenia, but failed to detect a pathogen. An increased glucose uptake exclusively in the liver was demonstrated by positron emission tomography. Liver biopsy showed basophilic inclusions in the cytoplasm of hepatocytes. Broad- range 16S rRNA gene PCR followed by sequence analysis yielded Spiroplasma sp. in two independent blood samples and the liver biopsy, confirming Spiroplasma sp. as the causative agent. Antibiotic treatment with doxycycline and azithromycin led to complete recovery.
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: N J
authors.initials: NJ
authors.lastname: Mueller
authors.affiliation: Division of Pulmonary Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: G M
authors.initials: GM
authors.lastname: Tini
authors.affiliation: Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Weber
authors.affiliation: Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Gaspert
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Husmann
authors.affiliation: Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Bloemberg
authors.affiliation: Division of Pulmonary Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Boehler
authors.affiliation: Division of Pulmonary Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Benden
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004269:DNA, Bacterial / Q000235:genetics; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D006505:Hepatitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D016867:Immunocompromised Host; D017563:Lung Diseases, Interstitial / Q000601:surgery; D016040:Lung Transplantation; D016133:Polymerase Chain Reaction; D011379:Prognosis; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D011877:Radionuclide Imaging; D013149:Spiroplasma / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D012336:RNA, Ribosomal, 16S
keywords: antibiotic: antibacterial; bacterial; clinical research / practice; infection and infectious agents; infectious disease; lung transplantation / pulmonology