Apple Core Lesions and Ulcerative Masses Due to Disseminated Yersinia enterocolitica in an Immunosuppressed Patient

Abstract

ABSTRACT A 68-year-old man with previous heart transplantation from a cytomegalovirus-positive donor presented with midabdominal pain, bloating, and weight loss. A computed tomography scan noted apple core lesions in the hepatic and splenic flexures, mesenteric lymphadenopathy, and hypoattenuating hepatic lesions concerning for malignancy. Colonoscopy visualized deep, cratered ulcers at both flexures, with extensive scattered ulcers throughout the colon. Biopsies were unrevealing for dysplasia, viral, and fungal causes. Liver lesion aspirates and stool culture eventually grew Yersinia enterocolitica. By diagnosis, the patient had gone into septic shock but improved after antibiotic initiation and remains clinically stable 4 months later.