(MULTIPLE LIVER-ABSCESSES CAUSED BY YERSI NIA-ENTEROCOLITICA WITHOUT ENTEROCOLITIS) - CASE-REPORT AND OVERVIEW

Five weeks after a tour-day visit to Malta, a 39-year old white male G erman national developed septic temperatures of up to 40-degrees-C, pr ogressive jaundice and a pronounced hepatosplenomegaly. The initial ex amination showed a very sick, somnolent patient with jaundice, cyanosi s, tachypnea and a markedly enlarged liver on both physical examinatio n and sonography. The laboratory evaluation revealed a moderate leukoc ytosis, markedly accelerated ESR, poor liver function with strongly el evated gamma-GT and alkaline phosphatase levels. Primary antibiotic th erapy consisted of doxycyclin. Ultrasound examination of the liver fou r days after admission revealed multiple hypodense abscesses. On the s ixth day after admission, gramnegative rods were first isolated from b lood cultures; antibiotic therapy was switched to ofloxacin (2 x 400 m g/day) and amoxycillin (3 x 2 g/day) after sensitivity testing. As a r esult of treatment with this combination of antibiotics, the patient w as free of fever 10 days after hospitalization; on the same day yersin ia enterocolitica was isolated from the first blood cultures taken on admission. The diagnosis of non-enteric forms of yersinia infection ca n prove very difficult, especially if the serology is not clear cut an d there are no immunological complications. A presentation including i ntermittent fever, moderate leukocytosis, strongly accelerated ESR and multiple hypodense abscesses in the liver should lead one to consider a non-enteric type of yersinia infection. Hepatic abscesses usually o ccur in patients who have an iron overload.