SHM Converge Scientific Abstract ePoster Gallery-Discovering a Rare Bacteremia in an Uncommon Congenital Biliary Disease

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This case report describes a rare bloodstream infection with <strong>Raoultella ornithinolytica</strong> in a <strong>20-year-old immunocompetent man</strong> whose underlying <strong>Caroli disease</strong> had not previously been recognized. Caroli disease is a congenital disorder characterized by segmental dilation of the intrahepatic bile ducts and is associated with recurrent cholangitis.

The patient presented with <strong>4 days of mid-abdominal pain, dark stools, vomiting, fever, and chills</strong>. He was tachycardic and had right upper quadrant tenderness, and blood cultures grew <strong>R. ornithinolytica</strong>. He was treated empirically with <strong>piperacillin-tazobactam</strong>, then narrowed to <strong>ceftriaxone and metronidazole</strong>. <strong>ERCP on hospital day 4</strong> supported the diagnosis of <strong>Caroli disease</strong>, and a sphincterotomy was performed. He was discharged on <strong>ursodiol</strong> and oral antibiotics. Imaging showed <strong>intrahepatic and extrahepatic bile duct dilation</strong>, strictures, and <strong>bilateral renal cysts</strong>, consistent with Caroli disease and possible related PKHD1-associated pathology.

After discharge, the patient had <strong>recurrent admissions</strong> for similar symptoms, with additional blood cultures growing <strong>Raoultella planticola</strong> and <strong>Klebsiella pneumoniae</strong>, reinforcing the link between unusual bacteremia and underlying biliary tract disease.

The authors emphasize that <strong>Raoultella bacteremia is typically associated with biliary disease</strong>, but this is the <strong>first reported case</strong> of <strong>R. ornithinolytica bloodstream infection in Caroli disease</strong>. The report highlights that finding Raoultella bacteremia in a young, otherwise healthy patient should prompt evaluation for <strong>occult biliary abnormalities</strong>.

Asset Subtitle

Elizabeth Klingensmith

Meta Tag

Author List Christina Brown, Elizabeth Klingensmith, Fazad Mohamed, Steven Duncan

Category Clinical Vignettes

Concept Raoultella ornithinolytica

Concept Caroli Disease

Concept Biliary Infection Coverage

Concept Cholangitis

Concept Gram-negative Bacterium

Distinguished Non-Finalist

Presenter Organization Sidney Kimmel Medical College

Presenting Author Elizabeth Klingensmith

Track Adult

Keywords

Raoultella ornithinolytica

bloodstream infection

Caroli disease

biliary disease

cholangitis

bacteremia

ERCP

intrahepatic bile duct dilation

immunocompetent man

occult biliary abnormalities

Raoultella ornithinolytica

Caroli Disease

Biliary Infection Coverage

Cholangitis

Gram-negative Bacterium