A Case of Raoultella Ornithinolytica Cholangitis in A Liver Transplant Recipient

We present the first documented case of Raoultella ornithinolytica bacteraemia in a patient with liver transplantation. R. ornithinolytica is a Gram-negative anaerobic bacterium found in aquatic environments in fish and birds, and is source of nosocomial infection causing pneumonia, enteritis, cholangitis or urinary infections, associated with surgical interventions in a hospital setting.

A 44-year-old female presented with a 2-day history of fever, rigors, and headache. Her past medical history was significant for having received three orthotopic liver transplants due to Wilson's disease over a 20-year period. Her physical examination was unremarkable besides stigmata of prior liver transplantation. Blood tests revealed mild elevations in liver function markers and raised inflammatory markers. R. ornithinolytica was eventually isolated from blood cultures. Subsequent magnetic resonance cholangiopancreatography (MRCP) demonstrated new left intrahepatic ductal dilation with heterogeneous peripheral enhancement. The proximal location of the cholangitis explained the lack of abdominal pain or tenderness. The patient was treated with appropriate antibiotic therapy and cultures were negative on day 2. The patient recovered without further intervention.

Seldom encountered R. ornithinolytica is uncommonly pathogenic but should be considered in patients receiving immunosuppressants and those with complex surgical anatomy.

This is the first case of Raoultella cholangitis in a liver transplant recipient described in the literature.Atypical clinical presentation and atypical infections are common in this patient group.Cholangitis should be suspected in all liver transplant recipients due to immunosuppression.