A 17‐year‐old white boy was admitted for 12 days of high fevers, nonbloody diarrhea, mild hearing loss, and a 5‐kg weight loss. He denied sick contacts or recent travel and had no significant prior medical or family history. On admission he was febrile, hypotensive, and dyspneic. His exam revealed injected conjunctiva, an erythematous posterior oropharynx, and mild epigastric tenderness, and his initial laboratory analysis was significant for anemia, acute kidney injury, and leukocytosis. In addition to persistent diarrhea and fevers up to 40.0°C, his hospital course was complicated by normocytic anemia requiring blood transfusions, a pleural effusion, hypoxia, lower‐extremity edema, arthralgias, and worsening bilateral hearing loss. A CT scan showed mesenteric adenitis, and a colonoscopy revealed ileitis. He was empirically started on cipro‐floxacin, metronidazole, and then piperacillin/tazobactam, with only a transient decrease in leukocytosis. Blood cultures and stool studies, including guaiac, bacterial cultures, and ova, parasite and viral tests, were negative. His lumbar puncture showed an elevated opening pressure, bone marrow biopsy revealed erythroid hypoplasia, and an audiology exam confirmed mild–moderate bilateral sensorineural hearing loss. His extensive workup also included unremarkable rheumatologic, immunologic, and inflammatory bowel disease studies as well as a normal echocardiogram, endoscopy, and MR enterography. Despite 8 days of intravenous antibiotics his fevers persisted. On the 24th day of his illness, Yersinia IgM, IgG, and IgA serologies were reported as positive, so he was started on cefotaxime. He quickly became afebrile, completed a total of 7 days of cefotaxime, and was discharged with 3 weeks of trimethoprim/sulfamethoxazole.
Although fever with diarrhea is not an uncommon problem for a pediatric hospitalist, this patient's complex and severe constellation of symptoms created several diagnostic dilemmas. Yersinia gastroenteritis is generally a benign, self‐limited condition, with common symptoms typically restricted to fever, diarrhea, and abdominal pain. Complications, such as reactive arthritis and erythema nodosum, occur infrequently, and serious illness is rare. The unusual severity of this patient's systemic response, anemia, and hypoxia resulted in an immense workup to uncover a relatively common etiology. The difficulty of isolating Yersinia species in stool cultures and its antibiotic resistance are well known and, in this case, further contributed to the difficulty of establishing a diagnosis. Importantly, Yersinia serologies provide a highly specific confirmatory test and, under the right clinical circumstances, should be sent despite negative stool studies. Of note, although the mechanism of Yersinia‐induced hearing loss remains unclear, this is the second reported case and the first in a pediatric patient.
This case illustrates the difficulty in elucidating the unknown etiology of a fever and describes a novel presentation of Yersinia gastroenteritis.
E. Biondi ‐ none; K. Dwyer‐Matzky ‐ none; B. Asselin ‐ none
To cite this abstract:Biondi E, Dwyer‐Matzky K, Asselin B. Yersinia Enteritis: A New Look for an Old Friend. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 241. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/yersinia-enteritis-a-new-look-for-an-old-friend/. Accessed April 21, 2019.