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Bacteremia with Raoultella planticola in the setting of acute pancreatitis complicated with acute cholangitis.

Bacteremia with Raoultella planticola in the setting of acute pancreatitis complicated with acute cholangitis.
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Merino Rodríguez E, Rebolledo Olmedo S, Miquel Plaza J,


Merino Rodríguez E, Rebolledo Olmedo S, Miquel Plaza J, (click to view)

Merino Rodríguez E, Rebolledo Olmedo S, Miquel Plaza J,

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Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva 2017 02 23109() doi 10.17235/reed.2017.4592/2016
Abstract

The bacterium Raoultella planticola (R planticola) is a rare pathogen in humans. We report a case of mild acute pancreatitis (MAP) of biliary origin with cholangitis and bacteremia with R planticola in association with pancreatic panniculitis (PP). A 55-year-old woman with rheumatic multiple valvulopathy presented with epigastric pain radiating to the back in a belt-like fashion for 48 hours, jaundice, choluria, acholia, and fever (38.2oC). Lab tests showed: amylase 2126 U/L, ALT 124 U/L, AST 169 U/L, GGT 3548 U/L, AP 1516 U/L, TBil 12.2 mg/dL, DBil 9.1 mg/dL. An abdominal ultrasound and CT scan revealed cholelithiasis and mild extrahepatic bile-duct dilatation (BDD), as well as changes consistent with MAP. She was admitted with a diagnosis of acute cholangitis and MAP, and empiric therapy was initiated with piperacillin-tazobactam. On day 2 painful, erythematous subcutaneous nodules developed in both legs, which were histologically compatible with PP. The blood culture was positive for R planticola and sensitive to the ongoing therapy. MR cholangiography ruled out BDD and choledocolithiasis. ERCP was decided against because of improved cholestasis parameters and the absence of obstructive disease, with spontaneous passage of bile duct stones being expected. On day 11 she was discharged from hospital in view of her positive outcome. Although R planticola is a known human pathogen since 1984, infection is rare. Fifteen bacteremia cases were found in the literature, of which 4 included cholangitis. It usually affects people with significant co-morbidities (usually immunodepressed individuals) related to trauma and/or prior invasive procedures. Prognosis is good as the pathogen is sensitive to most antibiotics, although resistance has already been reported. Our case is interesting in that bacteremia developed in an immunocompetent patient with no history of invasive procedures and in the setting of acute cholangitis and MAP, with the development of PP as a complication.

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