Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2024; 12(20): 4377-4383
Published online Jul 16, 2024. doi: 10.12998/wjcc.v12.i20.4377
Acute cholangitis with Achromobacter xylosoxidans bacteremia after endoscopic retrograde cholangiopancreatography in hilar cholangiocarcinoma: A case report
Ik Hyun Jo, Sung Woo Ko
Ik Hyun Jo, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16471, South Korea
Sung Woo Ko, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, South Korea
Author contributions: SW Ko conducted the study design; SW Ko and IH Jo corrected the data; SW Ko created the table and figures; IH Jo was the gastroenterologist of the patient and contributed to the original manuscript drafting; SW Ko and IH Jo reviewed, edited, and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any associated images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sung Woo Ko, PhD, Professor, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul 03312, South Korea. gogo930@catholic.ac.kr
Received: March 25, 2024
Revised: May 14, 2024
Accepted: May 27, 2024
Published online: July 16, 2024
Processing time: 97 Days and 2.8 Hours
Abstract
BACKGROUND

Achromobacter xylosoxidans is a Gram-negative opportunistic aerobe, usually causing nosocomial infections in immunocompromised patients with manifestations including bacteremia, pneumonia, and catheter-related infections. However, A. xylosoxidans have not yet been reported to cause biliary system infections.

CASE SUMMARY

A 72-year-old woman presented to the outpatient department of our hospital with a chief complaint of jaundice. Computed tomography of her abdomen revealed the presence of a mass of approximately 2.4 cm in the hilar portion of the common hepatic duct, consistent with hilar cholangiocarcinoma. We performed endoscopic retrograde cholangiopancreatography (ERCP) to decompress the obstructed left and right intrahepatic ducts (IHDs) and placed 10 cm and 11 cm biliary stents in the left and right IHDs, respectively. However, the day after the procedure, the patient developed post-ERCP cholangitis as the length of the right IHD stent was insufficient for proper bile drainage. The blood culture of the patient tested positive for A. xylosoxidans. Management measures included the replacement of the right IHD stent (11 cm) with a longer one (12 cm) and administering culture-directed antibiotic therapy, solving the cholangitis-related complications. After the cholangitis had resolved, the patient underwent surgery for hilar cholangiocarcinoma and survived for 912 d without recurrence.

CONCLUSION

A. xylosoxidans-induced biliary system infections are extremely rare. Clinical awareness of physicians and endoscopists is required as this rare pathogen might cause infection after endoscopic procedures.

Keywords: Achromobacter xylosoxidans, Bacteremia, Cholangitis, Endoscopic retrograde cholangiopancreatography, Malignant biliary stricture, Cholangiocarcinoma, Case report

Core Tip:Achromobacter xylosoxidans-induced biliary system infections has not been previously described. We present a rare cholangitis case after endoscopic retrograde cholangiopancreatography (ERCP) caused by A. xylosoxidans. Establishing adequate drainage for obstructed bile ducts during ERCP is essential to decrease the risk of post-ERCP cholangitis. In this case, cholangitis developed due to insufficient length of the biliary stent and was resolved by susceptible antibiotic administration and adequate biliary drainage at the second ERCP. As A. xylosoxidans-induced cholangitis has not been previously reported, the A. xylosoxidans contamination source remains unclear. Further investigation is needed to identify the colonization source and prevent endoscopy-associated infections.