Yersinia

Laura W. Lamps, MD

Key Facts

Etiology/Pathogenesis

Image Findings

May mimic acute appendicitis or Crohn disease
May show nonspecific features of enterocolic inflammation such as thickened bowel wall, adenopathy

Macroscopic Features

Microscopic Pathology

Diagnostic Checklist

Granulomatous inflammation with ulceration, mural fibrosis, and transmural lymphoid aggregates
Features closely mimic Crohn disease
Gram stain not helpful; consider culture, serologies, and molecular testing

Hematoxylin & eosin stain shows submucosal granulomas

with prominent lymphoid cuffs and giant cells, along with submucosal fibrosis in a patient with Yersinia enterocolitica infection.

Hematoxylin & eosin stain shows numerous epithelioid granulomas in the mesenteric node of a patient with yersiniosis.

TERMINOLOGY

Abbreviations

Synonyms

Definitions

Gram-negative coccobacilliform enteric bacteria that cause appendicitis, enterocolitis, and mesenteric lymphadenitis

ETIOLOGY/PATHOGENESIS

Environmental Exposure

Common food- and water-borne gastrointestinal pathogen
- Found in meat, water, and dairy products
1 of most common causes of bacterial enteritis in western and northern Europe
Incidence rising in Europe and USA

CLINICAL ISSUES

Presentation

Diarrhea
Abdominal pain
- Symptoms and signs of appendiceal Yersinia infection can mimic acute nonspecific suppurative appendicitis
  - Yersinia common cause of isolated granulomatous appendicitis
  - Patients with isolated granulomatous appendicitis rarely progress to generalized inflammatory bowel disease
- Lymphoid hyperplasia may cause ileal obstruction

Treatment

Usually self-limited in immunocompetent patients; require no therapy or supportive care
Patients presenting with appendicitis or bowel obstruction may require surgery

Prognosis

Excellent in immunocompetent patients
Immunocompromised or debilitated patients and those with iron overload at risk for more serious &/or chronic disease

IMAGE FINDINGS

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