Yersinia Gastroenteritis in an Immunosuppressed Patient: A Case Report

Abstract

Introduction Introduction: Yersinia enterocolitica is a foodborne pathogen able to withstand low temperatures and causing yersiniosis in humans, characterized by acute gastroenteritis and potentially severe conditions like sepsis. (1) Patients with other comorbidities such as immunosuppression, malignancy have a higher risk of yersiniosis. In 2021, 28 EU/EEA countries reported 6,876 confirmed cases of yersiniosis, with an overall rate of 1.9 cases per 100,000 population. (2) Enteropathogenic yersiniosis is usually harmless to healthy people but can be deadly for immunocompromised patients due to widespread bacterial infection, leading to a mortality rate of up to 50%. (3) Aim Discussion: A 67-year-old man with a history of gastric cancer underwent chemotherapy and subsequently developed recurrent diarrhea >6 times a day. He presented to the emergency department on the 9th day post-chemotherapy with severe symptoms including profuse vomiting, fever >38°C, and diarrhea without blood. Blood tests showed pancytopenia and CRP 76.7mg/l. He received intravenous fluids and Sol. Ampicillin/Sulbactam 1.5g x4/day. Treatment also included Smecta powder. After 2 days of treatment, the patient no longer had a fever or vomiting, but diarrhea with watery stools persisted 10 times a day. Further tests revealed worsening inflammation: CRP 111.8 mg/l., leukopenia, hypotension, fever leading to the septic condition and addition of IV Sol. Metronidazole. Stool and blood cultures identified Yersinia enterocolitica, sensitive to Ampicillin. The patient's condition gradually improved with decreased diarrhea and improved physical tolerance. After 3 days, CRP levels began to decrease (42.5 mg/l) and after 8 days of treatment, there was no bacterial growth in blood culture. He was discharged with a prescription for Sultamicillin tablets to continue for another 5 days. Conclusion Conclusion: Factors such as gastric cancer and chemotherapy leading to immunosuppression are risk factors for the development of Yersinia enterocolitica induced enterocolitis with septic condition.