A Rare Case of Pseudomonas aeruginosa-Associated Diarrhea in a Cirrhotic Patient
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Updated: Jun 15, 2025
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Published on: March 15, 2024
Malcolm Chapman1, Atul Lodh1, Joven Tristeza1
1University of Alabama Birmingham Department of Internal Medicine, Birmingham, AL, USA.
Abstract:
While rare, cases of community-acquired Pseudomonas aeruginosa (PsA) enterocolitis have been reported and are associated with recent antibiotic use and immunocompromised hosts. Here we present a 29-year-old immunocompetent female with newly diagnosed alcoholic cirrhosis that presents with bloody diarrhea and was found to have PsA in her stool culture. This case is unique as our patient does not have a history of recent antibiotic use or prior history of immunosuppression. However, immune dysfunction in cirrhosis results in defects in both innate and acquired immunity, thus predisposing our patient to PsA-associated diarrhea. Overall, this case showcases that, while considered immunocompetent, cirrhotic patients are predisposed to rare infections such as PsA in the community due to defects in their immune system.
Insights
Community-acquired Pseudomonas aeruginosa (PsA) enterocolitis is rare, but cirrhotic patients, even if immunocompetent, are susceptible due to immune dysfunction. This case highlights PsA diarrhea risk in cirrhosis without typical predisposing factors.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Immunology
Background:
- Community-acquired Pseudomonas aeruginosa (PsA) enterocolitis is uncommon, typically linked to antibiotic use and immunocompromised states.
- Cirrhosis is associated with immune dysfunction, affecting both innate and adaptive immunity, increasing susceptibility to infections.
Observation:
- A 29-year-old immunocompetent female with newly diagnosed alcoholic cirrhosis presented with bloody diarrhea.
- Stool cultures revealed the presence of Pseudomonas aeruginosa (PsA).
Findings:
- The patient had no history of recent antibiotic use or prior immunosuppression, making this a unique presentation.
- Immune dysfunction inherent in cirrhosis, affecting both innate and acquired immunity, is identified as the predisposing factor for PsA-associated diarrhea.
- This case demonstrates that cirrhotic patients, despite being clinically immunocompetent, are at increased risk for rare community-acquired infections like PsA.
Implications:
- Clinicians should consider PsA enterocolitis in cirrhotic patients presenting with diarrhea, even in the absence of typical risk factors.
- The findings underscore the importance of recognizing immune dysregulation in cirrhosis as a significant risk factor for opportunistic infections.
- This case contributes to understanding the spectrum of infections associated with liver disease and highlights the need for vigilant diagnosis and management.
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