Severe infection with multidrug-resistant in a young patient with primary sclerosing cholangitis.

Massive global spread of multidrug-resistant (MDR) spp. expressing extended-spectrum beta-lactamase (ESBL) and additional resistance to fluoroquinolones has often been attributed to high international mobility as well as excessive use of oral antibiotics in livestock farming. However, MDR spp. have not been mentioned as a widespread pathogen in clinical settings so far. We demonstrate the case of a 25-year-old male with primary sclerosing cholangitis who tested positive for MDR serotype Choleraesuis expressing ESBL and fluoroquinolone resistance. The pathogen was supposedly acquired during a trip to Thailand, causing severe fever, cholangitis and pancreatitis. To our knowledge, this is the first report of serotype Choleraesuis in Europe expressing such a multidrug resistance pattern. ESBL resistance of spp. should be considered in patients with obstructive biliary tract pathology and travel history in endemic countries.