SHM Converge Scientific Abstract ePoster Gallery-A Rare Infection From the Kingdom of Elizabethkingia

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This case report describes a fatal biliary-source infection caused by <strong>Elizabethkingia species</strong>, a rare gram-negative, multidrug-resistant organism found in water and soil. An <strong>86-year-old woman with advanced dementia</strong> presented with <strong>four days of worsening encephalopathy, jaundice, poor oral intake, weakness, and vague abdominal pain</strong>. On admission, she was in <strong>septic shock</strong> and required multiple vasopressors. Laboratory tests showed <strong>hyperbilirubinemia and transaminitis</strong>, suggesting mixed hepatocellular-cholestatic injury.

Imaging supported <strong>acute cholecystitis/cholangitis</strong>: ultrasound and CT showed <strong>cholelithiasis, a distended gallbladder, and gallbladder wall thickening</strong>. A HIDA scan showed no radiotracer activity in the gallbladder or small bowel, indicating possible biliary obstruction. Because she was unstable, she underwent <strong>urgent percutaneous cholecystostomy</strong>.

Blood cultures grew <strong>Elizabethkingia spp.</strong>, and repeat cultures confirmed bacteremia. The gallbladder drainage cultures were negative. Due to the rarity of the organism and lack of available speciation and sensitivity testing, antibiotics were changed from empiric therapy to <strong>minocycline and piperacillin-tazobactam</strong> with Infectious Diseases consultation. Despite treatment and supportive care, the patient deteriorated into <strong>multiorgan failure</strong>, including refractory shock, respiratory failure, reduced ejection fraction, renal failure, and disseminated intravascular coagulation. After nine days in the ICU, the family chose comfort-focused care, and she was compassionately extubated.

The authors note that only a few hundred Elizabethkingia infections have been reported, most identified after bacteremia develops. <strong>Elizabethkingia bacteremia has a high mortality rate of 25–30%</strong>, and resistance to many common antibiotics makes management difficult. This case highlights <strong>biliary sepsis as a possible source</strong> of adult Elizabethkingia infection and emphasizes the need for more research on diagnosis, susceptibility testing, and treatment.

Asset Subtitle

Christina So

Meta Tag

Author List Christina Desai, Christina So, Colin Tsui, Deborah Carlson, Hannah Robinson, Rahul Jalota, Robert Bernstein

Category Clinical Vignettes

Concept Elizabethkingia

Concept Septic Shock

Concept Bacteremia

Concept Antibiotic Resistance

Concept Source Control

Distinguished Non-Finalist

Presenter Organization Community Memorial Healthcare

Presenting Author Christina So

Track Adult

Keywords

Elizabethkingia

biliary sepsis

bacteremia

septic shock

acute cholecystitis

cholangitis

multidrug-resistant infection

percutaneous cholecystostomy

minocycline

multiorgan failure

Elizabethkingia

Septic Shock

Bacteremia

Antibiotic Resistance

Source Control