SHM Converge Scientific Abstract ePoster Gallery-Beyond the Nasopharynx: S. Pneumoniae Bacteremia From a Biliary Source

Pdf Summary

This case report describes a 57-year-old woman with a history of cholecystectomy, choledocholithiasis, and repeated biliary stent placement who presented with fever, rigors, nausea, vomiting, and epigastric pain radiating to the back. Labs showed elevated liver enzymes, and MRCP demonstrated common bile duct dilation with stones in the distal biliary stent. She was treated for sepsis due to choledocholithiasis and evolving Grade I cholangitis.<br /><br />During hospitalization, ERCP revealed pus, sludge, and stones, confirming cholangitis; the biliary stents were replaced. Admission blood cultures unexpectedly grew penicillin-resistant Streptococcus pneumoniae. Because pneumococcal bacteremia is usually linked to respiratory infection, clinicians performed a broad workup: chest X-ray, transthoracic echocardiography, urinalysis, respiratory viral testing, and transesophageal echocardiography. These studies did not identify another source of infection. With no alternative explanation and ERCP findings consistent with biliary infection, the team concluded the bacteremia most likely originated from the biliary tree. She improved with intravenous antibiotics and recovered without complications.<br /><br />The discussion emphasizes that S. pneumoniae is a rare cause of cholangitis because it typically does not survive well in bile. However, prior reports suggest biliary pneumococcal infections may occur in patients with obstructive biliary disease and biliary instrumentation such as stents. This case supports considering a biliary source when S. pneumoniae bacteremia occurs in patients with relevant biliary history, even if bile cultures are not obtained.<br /><br />The authors conclude that in such patients, prompt treatment of the bacteremia and underlying biliary disease may be more important than definitive microbiologic proof of the biliary source.

Asset Subtitle

Gary Wang

Meta Tag

Author List Alexandre Zaharia, Daniel Klarr, Gary Wang

Category Clinical Vignettes

Concept Streptococcus pneumoniae

Concept Biliary Tract Infection

Concept Bacteremia

Concept Prompt Treatment

Concept Hepatobiliary Source

Distinguished Non-Finalist

Presenter Organization University of Chicago Pritzker School of Medicine

Presenting Author Gary Wang

Track Adult

Keywords

cholangitis

choledocholithiasis

biliary stent

Streptococcus pneumoniae

bacteremia

ERCP

sepsis

common bile duct dilation

biliary obstruction

pneumococcal infection

Streptococcus pneumoniae

Biliary Tract Infection

Bacteremia

Prompt Treatment

Hepatobiliary Source