Pseudoappendicitis due to Yersinia pseudotuberculosis: A Case Report with a Fatal Outcome

Abstract

Yersinia species often cause enterocolitis or pseudoappendicitis. Yersiniosis is mostly transmitted by raw or undercooked foods, namely pork. Clinical severity is related to states of immunosuppression or iron overload. We present the clinical case of a 79-year-old man with a history of hypertension and diabetes, who was admitted to the emergency department for right low back pain with anterior irradiation to the right iliac fossa (RIF). Analytically with leukocytosis, neutrophilia, and C-reactive protein and procalcitonin elevated. Abdominal computed tomography revealed a liquid collection of about 60 x 40 mm in the RIF. The clinical status evolved to septic shock with suspicion of starting point in appendicitis. Although antibiotic therapy with piperacillin/tazobactam, and isolation in blood cultures of susceptible Yersinia pseudotuberculosis, the patient eventually died. The low prevalence and the ability to mimic other diseases makes difficult to diagnose this entity. The case warns of the absence of response to early treatment with broad-spectrum antibiotic therapy, which questions the possibility of virulence factors yet to be identified,
as well as the need to determine which antibiotic is more
effective according to clinical severity.