Case Report
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World J Gastroenterol. Oct 7, 2013; 19(37): 6296-6298
Published online Oct 7, 2013. doi: 10.3748/wjg.v19.i37.6296
An ironic case of liver infections: Yersinia enterocolitis in the setting of thalassemia
Nathan Selsky, Faripour Forouhar, George Y Wu
Nathan Selsky, George Y Wu, Division of Gastroenterology and Hepatology, Department of Medicine, University of Connecticut Health Center, Farmington, CT 06030, United States
Faripour Forouhar, Department of Anatomic Pathology, University of Connecticut Health Center, Farmington, CT 06030, United States
Author contributions: All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data, drafting the article, and had final approval of the version to be published.
Correspondence to: George Y Wu, MD, PhD, Division of Gastroenterology and Hepatology, Department of Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, United States. wu@nso.uchc.edu
Telephone: +1-860-6792509 Fax: +1-860-6793159
Received: May 3, 2013
Revised: July 5, 2013
Accepted: July 30, 2013
Published online: October 7, 2013
Abstract

A 49 years old Vietnamese male with a history of thalassemia, presented with gastrointestinal symptoms and signs of hemolysis. He was diagnosed with yersinia enterocolitis. Yersinia is a gram-negative rod that most frequently occurs in children especially during the winter months. In the current case, the bone marrow biopsy showed hemophagocytosis along with positive cultures for Yersinia. The microorganism likely triggered hemophagocytosis. This syndrome, also known as, hemophagocytic lymphohistiocytosis, is defined by fever for more than 7 d, cytopenia of two or more cell lines, hemophagocytosis, hepatitis, serum ferritin greater than 500, jaundice, lymphadenopathy, and hepatosplenomegaly. This disorder can be either familial or secondary to a strong immunologic activation. Both have an overwhelming activation of T-cells and macrophages.

Keywords: Yersinia, Enterocolitis, Bone marrow, Liver biopsy, Thalassemia, Hemophagocytic lymphohistiocytosis

Core tip: In the current case, the bone marrow biopsy showed hemophagocytosis along with positive cultures for Yersinia. The microorganism likely triggered hemophagocytosis. This syndrome, also known as, hemophagocytic lymphohistiocytosis, is defined by fever for more than 7 d, cytopenia of two or more cell lines, hemophagocytosis, hepatitis, serum ferritin greater than 500, jaundice, lymphadenopathy, and hepatosplenomegaly. This disorder can be either familial or secondary to a strong immunologic activation. Both have an overwhelming activation of T-cells and macrophages.