Introduction
Yersinia pseudotuberculosis is a facultative anaerobic,
Gram-negative, motile, non-spore-forming bacillus, belonging to the
family Yersiniaceae. Y. pseudotuberculosis is a rare zoonotic
infection, which may be transmitted to humans through contact with
infected animals or after ingestion of contaminated food or
water.1 The most common manifestations of infection
with Y. pseudotuberculosis in humans are enterocolitis, terminal
ileitis and/or mesenteric lymphadenitis, initially often interpreted as
acute appendicitis, therefore sometimes characterized as
pseudoappendicitis.2
A pyogenic liver abscess (PLA) is pus-filled cavity within the liver due
to a bacterial infection.3 The annual incidence of PLA
has been reported between 1-7 cases per 100,000 in some Western
Countries and higher among men than women4,5,6 , while
higher rates have been reported in Taiwan (17.6 per 100,000) withKlebsiella pneumoniae as the primary pathogen.7The majority of PLA occurs in patients with pre-existing
gastrointestinal or biliary disease and originates from hematogenous
spread though the portal vein. The most common pathogens includeKlebsiella pneumoniae, Escherichia coli, Streptococcusanginosus -group, Enterococcus species and anaerobic
bacteria such as Bacteroides species or Fusobacteriumspecies.3 But, in some cases, the etiologic
microorganisms remain unidentified. This is particularly common, when
abscess drainage is difficult and antibiotics are initiated before
abscess puncture resulting in culture-negative PLA.8
Sepsis with Y. pseudotuberculosis is rare, but have been
described in patients with underlying medical conditions such as
diabetes mellitus, malignancy, iron overload, and liver
disease.1,2 Though uncommon, infections with Y.
pseudotuberculosis disseminated through the blood stream have been
described, including hepatic9-14,
splenic13,15 and pulmonary
abscesses16, peritonitis2,
myocarditis2, osteomyelitis17 and
meningitis.2 Here, we describe the first Danish case
of Y. pseudotuberculosis PLA in a patient with newly diagnosed
diabetes mellitus.