Aeromonas species do not commonly cause disease in humans. However, when disease is seen, it often occurs in patients with underlying immunosuppression or
malignancy and has a high fatality rate.
CASE PRESENTATION: A 72-year-old Japanese woman with
rheumatoid arthritis treated with
tocilizumab (which has an immunosuppressive effect) presented with severe epigastric
pain. She had a
fever with
chills,
hypotension and
jaundice. She was diagnosed with acute suppurative
cholangitis and treated with
cefoperazone-
sulbactam and an endoscopic drainage was performed.
Jaundice was slightly improved, but the
shock state and inflammatory reactions were prolonged as typical of
septic shock. On the second day after admission, an electrocardiogram showed ST segment elevation and echocardiography showed ventricular wall dysfunction. Coronary arteries were patent in coronary angiography and she was diagnosed with stress-induced
cardiomyopathy. Blood cultures showed Aeromonas hydrophila. A stool culture was negative for A. hydrophila. On day six, her white blood cell count and neutrophils were normalized and
cefoperazone-
sulbactam treatment was halted. Left ventricular function normalized on day twelve and a
laparoscopic cholecystectomy for
cholelithiasis was performed on the 16th day of hospitalization. A culture from the bile showed A. hydrophila. Eighteen days after surgery,
tocilizumab treatment was restarted and there were no complications. Two months after restarting
tocilizumab, our patient is stable without any serious events.
CONCLUSION: