Case of terminal ileitis due to Yersinia pseudotuberculosis

Abstract

A 26-year-old housewife was admitted because of right lower quadrant pain of 4 days duration, vomiting, dizziness and fever. At the time of admission, body temperature was 38.2°C and leucocyte count was 8200 per cu mm. Percussion tenderness on abdomen was maximum at McBurney's point but muscular guarding and Blumberg's sign were equivocal.She was treated symptomatically without laparatomy. Abdominal pain decreased in severity with subsiding of fever within 10 days after the onset of illness. Slight ileocecalgia, however, had persisted for about one and half months.Alimentary X-ray examination on the 17th and 34th days of illness revealed hyperplasia of mucosal folds and stenosis of the terminal ileum with regional tenderness. X-ray examination, however, on the 72nd day, when she had become free from complaints, disclosed resolution of the pathological findings before observed. Thus diagnosis of terminal ileitis was decided.A strain of Yersinia was isolated from feces of the 9th day of illness. Its biochemical properties were identical to Y. pseudotuberculosis. Cross-absorption test for O-antigen showed that the strain was antigenically similar to the reference strain, Y. pseudotuberculosis type III (No.83).Agglutinin titer of convalescent serum to O-antigen of patient's own strain was 1: 160 on the 34th day.The organism, when isolated, was non-motile but became motile after serial subcultures at 25°C using Cragie's tubes. The motile strain showed several peritrichous flagella under electron microscope.Single-disc sensitivity test revealed the organism to be sensitive to benzyl-penicillin, cephaloridine, gentamicin, nalidixic acid and sulfisomezole and resistant to streptomycin, erythromycin and spiramycin.