Clinical diagnosis
Case 43
Stool culture and biopsy culture detected Yersinia bacillus and led to final diagnosis of Yersinia enterocolitis. The symptoms of abdominal pain and diarrhea were getting improved and then, he did not expect to be given medicine. Thereafter, the symptoms naturally relieved without help of medicine.
【Discussion】
Organisms of Yersenia enterocolitica and Yersenia pseudotuberculosis which are gram-negative bacillus bacteria, live in wild mouse and cattle, especially pig (1-6). They are active at temperatures between 19-22°C but not so active at 37 °C and can survive in the low temperature environment such as modern cooling system (1-3). Yersenia enterocolitis is acquired by ingestion of contaminated vegetable, raw pig intestine or water (1-6). The outbreak of Yersenia enterocolitis most occurs from school lunch although the contaminated food is not usually easy to identify (5, 6). The main reason of the difficulty, is the long latent period of 2 to 5 days (5, 6). The usual symptoms include diarrhea, low-grade fever and abdominal pain lasting 1-3 weeks (1-4). Diarrhea might be mucoid and/or bloody. Most cases are self-limited. Sepsis might rarely occur and bacteremia possibly occurs in infants (1-4). In our case aged 35, it was unclear when he was infected or what was the contamination food ingested. The mucoid bloody diarrhea and slight abdominal pain continued for 2 months.
The typical image of Yersenia enterocolitis includes terminal ileitis, mesenteric lymphadenitis and pseudo-appendicitis (4). Namely, after having contamination food, Yersenia organisms multiply in the terminal ileum and invade Peyer’s patches, inducing lymphadenitis (1-4). This infection style mimicked with appendicitis, named pseudo-appendicitis. In our case, marked swollen ileum and swollen cecum, ascending and transverse colon were found with the swollen lymphnodes around cecum. Further, the unique findings of this case were that there existed erosions and mural edema existed in the rectum. Then, it was easy to differentiate from appendicitis but it is required to differentiate from Crohn’s disease and colon amebiasis.
Colon amebiasis is caused by Entamoeba histolytica which is found in the warming countries. Accompanied with global warming, the reported cases of colon amebiasis are getting increased in Japan. This parasite stays in the terminal ileum and transformed into invasive form, penetrating and invading the colonic mucosal barrier and leading to ulcer, mucoid bloody diarrhea and colitis resembling infectious colitis (7-9). Meanwhile, Crohn’s disease usually happens in ileocolic region ; ileocolic type, 50%; ileitis type, 30 %; colitis type, 20% (9-11). In our case, histological examination of biopsy revealed no evidence of colon amebiasis and Crohn’s disease but cultivation of both of stool and biopsy revealed Yersinia colitis.
【Summary】
We present a thirty five-year-old male suffering from secretary bloody diarrhea for 2 months. Abdominal CT showed marked edematous terminal ileum and ascending colon with peri-cecum and peri-ileum end lymphnodes swelling. Colon endoscopy showed multiple white erosions with mucosal edema at ileum from 15 cm oral site to ileum end accompanied with multiple erosions in the entire colon. Stool and biopsy culture revealed Yersinia colitis. We should keep in mind that ileum end is susceptible to yersinia colitis , colon amebiasis, Crohn’s disease, Behcet’s disease and lymphoma.
【References】
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2017.2.22
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