Acute Cholangitis with Common Bile Duct Stone Caused by <i>Lactococcus garvieae</i>: A Case Report

Abstract

<i>Lactococcus garvieae</i> is a Gram-positive cocci that has been known to be a fish pathogen, and considered as a low virulence organism rarely associated with human infection. We report a case of acute cholangitis with common bile duct (CBD) stone and bacteremia by <i>L. garvieae</i> bacteremia in a 70-year-old male. The patient presented with epigastric pain and was diagnosed with two CBD stones. Blood culture obtained prior to empiric antimicrobial therapy with ceftizoxime sodium showed growth with <i>Escherichia coli</i> and <i>L. garvieae</i>. The bacteria were confirmed by matrix-assisted desorption/ionization time-of-flight mass spectrometry. Initial attempt at endoscopic biliary drainage failed, and the patient underwent percutaneous transhepatic biliary drainage and subsequent stone removal. He occasionally ingested raw fish and had a history of gastric ulcer with acid suppression therapy, which could be possible risk factors for <i>L. garvieae</i> infection. This is the first case of <i>L. garvieae</i> bacteremia in acute cholangitis.