Biliary Sepsis Caused by Burkholderia cepacia: A Rare Presentation

Burkholderia cepacia is notorious for causing nosocomial pneumonia in immunocompromised patients, while extrapulmonary infections remain uncommon. We report the case of a 53-year-old man recently diagnosed with lung adenocarcinoma with liver and spine metastases who initially presented with obstructive jaundice. Laboratory workup revealed elevated alkaline phosphatase, alanine aminotransferase, and direct hyperbilirubinemia. Baseline chest X-ray showed a soft tissue density in the left lower lobe, and dynamic liver CT demonstrated multiple liver nodules suspicious for metastasis. He underwent endoscopic retrograde cholangiopancreatography with stent insertion. Post-procedure, the patient developed a fever. He was managed as a case of cholangitis and started on piperacillin-tazobactam. Blood cultures grew B. cepacia, which was sensitive to meropenem, levofloxacin, and cotrimoxazole; therefore, antibiotics were shifted to meropenem. Despite this, he remained febrile. Magnetic resonance cholangiopancreatography showed dilatation of both the hepatic and common bile ducts with the stent in place. The team proceeded with percutaneous transhepatic biliary drainage. Bile cultures again grew B. cepacia with the same sensitivities. Repeat blood cultures remained positive, so levofloxacin was added to meropenem. Two days after starting the combination regimen, the patient became afebrile. Subsequent blood cultures showed clearance. He was discharged in stable condition with two weeks of oral levofloxacin. B. cepacia should be considered a possible causative agent of nosocomial biliary tract infections in immunocompromised patients.