Pemphigus foliaceus complicated by sepsis of the aetiology of Yersinia enterocolitica after eating cheesecake

Yersinia enterocolitica is a bacterium that can be commonly found in water and soil [1]. People usually become infected with the bacteria through contact with farm animals and products made from them. Yersiniosis is a disease that may be manifested by food poisoning, enteritis, arthritis or even sepsis. There are non-specific symptoms of the disease such as abdominal pain, diarrhoea, and vomiting [2–4]. Yersinia spp. infection is most commonly manifested by reactive arthritis in consequence of an earlier diarrhoea [5]. Diarrhoea is usually mild. It is rarely associated with yersiniosis. It disappears spontaneously. Patients tend to associate diarrhoea with a viral infection or indigestion rather than yersiniosis. When patients with diarrhoea contact a family doctor, they are usually tested for Salmonella or Clostridium difficile. Doctors rarely suspect infection with Yersinia spp. and therefore do not test patients’ stool for these bacterial cultures. Even when a patient has diarrhoea, it is difficult to culture Yersinia spp. under standard laboratory conditions for 24 h at a temperature of 37°C. It is almost impossible to detect Yersinia spp. in a standard stool test due to the multitude of other Gram-negative rods of the Enterobacteriaceae family in this material. Measurement of the concentration of Yersinia spp. antibodies does not indicate an active form of the disease but it shows that the patient had contact with these bacteria. Yersinia spp. may be ignored if there are no acute symptoms or if the patient has not been given standard tests for the presence of the bacteria. Yersinia spp. infection is usually taken into consideration when the patient suffers from a severe joint disease and when all other factors which may have caused the disease have been excluded. This form of yersiniosis usually occurs in consequence of diarrhoea, which was not treated with an antibiotic because the symptoms went away spontaneously, but Yersinia spp. remained in the patient’s joints. Yersinia spp. may cause severe illness in patients with immunodeficiency [6, 7], like in the case of a patient with pemphigus foliaceus who developed sepsis. Recent observations have shown that the percentage of generalised infections caused by Yersinia spp. is increasing. These severe infections may develop in an increasing population of patients with diabetes [8], immunodeficiency or those undergoing immunosuppressive therapy.
A woman, 71, with pemphigus foliaceus was admitted...


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