Hong Jason, Steen Christopher, Wong Enoch, Keong Ben
Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
Department of General Surgery, Box Hill Hospital, Box Hill, Victoria, Australia.
BMJ Case Rep. 2020 Dec 10;13(12):e237655. doi: 10.1136/bcr-2020-237655.
We present a case of recurrent cholangitis caused by , a lethal, emerging pathogen that clinicians should be made aware of. An 86-year-old man with a history of gastrectomy for peptic ulcer disease and a cerebrovascular accident with known choledocholithiasis presented with recurrent episodes of cholangitis that failed conservative antibiotic treatment regimens. has been described to have increasing resistance to piperacillin and tazobactam. Both and multidrug-resistant were co-isolated in this patient, which required broader spectrum antibiotics for successful treatment and management. A high index of suspicion is required if the history is suggestive of marine or aquatic exposure, which could expose the patient to this lethal pathogen. Re-thinking and re-taking the history are important cornerstones in refining the diagnosis when faced with recurrent presentations of the same problem.
我们报告一例由[病原体名称未给出]引起的复发性胆管炎病例，这是一种致命的新出现病原体，临床医生应予以关注。一名86岁男性，有因消化性溃疡疾病行胃切除术史及脑血管意外史，已知患有胆总管结石，出现复发性胆管炎发作，保守抗生素治疗方案无效。[病原体名称未给出]已被描述为对哌拉西林和他唑巴坦的耐药性增加。该患者同时分离出[病原体名称未给出]和多重耐药的[另一种病原体名称未给出]，这需要使用更广谱的抗生素才能成功治疗和管理。如果病史提示有海洋或水生环境暴露，就需要高度怀疑，因为这可能使患者接触到这种致命病原体。当面对同一问题的反复出现时，重新思考和询问病史是完善诊断的重要基石。
