Yersinia enterocolitica infection with multiple liver abscesses uncoveringa primary hemochromatosis

A 60-year-old man, although treated with antibiotics, suffered from a sever e pyrexial illness of unknown origin, weight loss and intermittent abdomina l pain. There was no history of diarrhea or common infections. Computed tom ography and ultrasound imaging showed uncharacteristic multiple small lesio ns of the entire liver parenchyma. These lesions were histologically pyogen ic abscesses. In addition, an unexpected, pronounced accumulation of iron p igment in hepatocytes and second degree fibrotic changes of the liver were detected. Serum iron and serum transferrin were low, but serum ferritin con centration and transferrin saturation were increased to the maximum. The de monstration of the cysteine-282-tyrosine mutation confirmed underlying prim ary hemochromatosis. Bacteriological cultures of the abscess material yield ed Yersinia enterocolitica serotype O:3, while stool and blood cultures wer e negative. Antibiotic therapy with piperacillin/tazobactam and tobramycin was successful within a few days. A repeat CT scan and ultrasound imaging d emonstrated complete regression of the pathologic liver morphology. The pat ient was discharged and treated with an orally administered fluoroquinolone for an additional 6 months. After this time the patient had no morphologic al residues of the infection except one enlarged lymph node near the portal vein but still was so weak that he was unable to work again. In conclusion , severe septic forms of yersiniosis are mainly found in patients with iron overload, due to a handicapped iron metabolism of the Yersinia bacteria. M ortality is high despite treatment.