Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2015; 21(25): 7911-7915
Published online Jul 7, 2015. doi: 10.3748/wjg.v21.i25.7911
Helicobacter cinaedi bacteremia with cellulitis after ABO-incompatible living-donor liver transplantation: Case report
Kohei Mishima, Hideaki Obara, Kayoko Sugita, Masahiro Shinoda, Minoru Kitago, Yuta Abe, Taizo Hibi, Hiroshi Yagi, Kentaro Matsubara, Takehiko Mori, Yaoko Takano, Hiroshi Fujiwara, Osamu Itano, Naoki Hasegawa, Satoshi Iwata, Yuko Kitagawa
Kohei Mishima, Hideaki Obara, Masahiro Shinoda, Minoru Kitago, Yuta Abe, Taizo Hibi, Hiroshi Yagi, Kentaro Matsubara, Osamu Itano, Yuko Kitagawa, Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
Kayoko Sugita, Yaoko Takano, Hiroshi Fujiwara, Naoki Hasegawa, Center for Infectious Diseases and Infection Control, Keio University School of Medicine, Tokyo 160-8582, Japan
Takehiko Mori, Division of Hematology, the Department of Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
Satoshi Iwata, Department of Infectious Diseases, Keio University School of Medicine, Tokyo 160-8582, Japan
Author contributions: Mishima K and Obara H wrote this paper; Sugita K performed analysis of blood culture and gene sequence; all other members equally contributed to medical treatment.
Ethics approval: The study was reviewed and approved by the Keio University School of Medicine Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hideaki Obara, MD, PhD, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. obara@z3.keio.jp
Telephone: +81-3-33531211 Fax: +81-3-33554707
Received: March 3, 2015
Peer-review started: March 4, 2015
First decision: April 13, 2015
Revised: May 9, 2015
Accepted: May 21, 2015
Article in press: May 21, 2015
Published online: July 7, 2015
Processing time: 127 Days and 22.5 Hours
Abstract

Helicobacter cinaedi (H. cinaedi), a Gram-negative spiral-shaped bacterium, is an enterohepatic non-Helicobacter pylori Helicobacter species. We report the first case of H. cinaedi bacteremia with cellulitis after liver transplantation. A 48-year-old male, who had been a dog breeder for 15 years, underwent ABO-incompatible living-donor liver transplantation for hepatitis C virus-induced decompensated cirrhosis using an anti-hepatitis B core antibody-positive graft. The patient was preoperatively administered rituximab and underwent plasma exchange twice to overcome blood type incompatibility. After discharge, he had been doing well with immunosuppression therapy comprising cyclosporine, mycophenolate mofetil, and steroid according to the ABO-incompatible protocol of our institution. However, 7 mo after transplantation, he was admitted to our hospital with a diagnosis of recurrent cellulitis on the left lower extremity, and H. cinaedi was detected by both blood culture and polymerase chain reaction analysis. Antibiotics improved his symptoms, and he was discharged at day 30 after admission. Clinicians should be more aware of H. cinaedi in immunocompromised patients, such as ABO-incompatible transplant recipients.

Keywords: Helicobacter cinaedi; Bacteremia; Cellulitis; Liver transplantation; Hepatitis C; Living-donor; ABO-incompatible; HBc-Ab-positive donor

Core tip: This is the first case report of Helicobacter cinaedi infection in a liver transplant recipient. Clinicians should be aware of this microorganism when treating immunocompromised patients, such as ABO-incompatible liver transplant recipients with symptoms of cellulitis.