Extra-intestinal Edwardsiella tarda infection presenting as sequential cholecystitis and cholangitis: a case report

Edwardsiella tarda (E. tarda) is a rare human pathogen. Extra-intestinal infections of E. tarda are particularly uncommon, with only one case of recurrent cholangitis caused by E. tarda reported to date.

A 77-year-old man suffered acute calculous cholecystitis 5 days after eating eel and raw fish. Culture results from bile obtained via percutaneous gallbladder drainage revealed E. tarda infection, and an 8-day course of intravenous cefmetazole led to clinical resolution. However, the patient returned with fever and laboratory signs of obstructive cholangitis 5 weeks later. Contrast-enhanced computed tomography showed a migrated gallstone in the distal common bile duct. Endoscopic retrograde cholangiopancreatography drained the purulent bile, and cultures from the bile and blood were again positive for E. tarda. A 10-day course of cefmetazole, along with biliary stent placement resulted in complete recovery.

E. tarda can cause relapsing biliary tract infections despite appropriate initial treatment. Clinicians should consider this rare pathogen in cases of recurrent cholangitis, especially for patients with recent consumption of raw or undercooked aquatic animals. A detailed dietary history and targeted microbiological testing are essential for accurate diagnosis and management.