Non-O1/Non-O139 Vibrio cholerae Bacteremia Presenting as Spontaneous Bacterial Peritonitis in Decompensated...

Non-O1/non-O139 Vibrio cholerae is an emerging invasive pathogen in immunocompromised individuals, particularly those with chronic liver disease, although it is more commonly associated with mild gastrointestinal illness. A 56-year-old male with decompensated cirrhosis presented with fever, abdominal distension, and abdominal pain, suggestive of spontaneous bacterial peritonitis (SBP). Ascitic fluid analysis supported SBP; however, ascitic fluid culture remained sterile. Blood culture flagged positive within 10 hours and revealed curved, Gram-negative bacilli identified as V. cholerae. Serotyping confirmed a non-O1/non-O139 strain, and polymerase chain reaction (PCR) assays for cholera toxin gene (ctxA) and toxin-coregulated pilus gene (tcpA) were negative. The isolate was susceptible to commonly tested antimicrobials, and the patient improved following treatment with piperacillin-tazobactam. This report documents an unusual case of non-O1/non-O139 V. cholerae bacteremia presenting with SBP-like features in a cirrhotic patient and reviews the literature regarding the pathophysiology and clinical significance of this emerging pathogen in immunocompromised hosts, highlighting the importance of early recognition and prompt microbiological diagnosis for appropriate management.