2023 Volume 72 Issue 2 Pages 301-305
The patient is a 67-year-old male who had been diagnosed as having hilar bile duct cancer and had been visiting our hospital for treatment. He was found collapsed on the sidewalk and was urgently transported to our hospital. He was diagnosed as having cholangitis and septic shock, and meropenem was administered as the initial treatment. Gram staining of blood culture collected on admission showed Gram-negative small rods suspected of being Haemophilus influenzae, and a bile specimen obtained by endoscopic biliary drainage only showed the same Gram-negative small rods. Culture results showed non-β-lactamase-producing ampicillin-resistant H. influenzae in both specimens. The patient was discharged from the hospital after de-escalation of antimicrobial therapy to ceftriaxone with the improvement of the inflammatory response. Invasive H. influenzae infections in adults are mainly caused by bacteremia and associated pneumonia, and although there have been reports of cholangitis-associated infections, detection of H. influenzae in bile specimens is rare. On the basis of the present case, we believe that when Gram-negative short rods are detected in bile specimens, chocolate agar culture should be considered, taking into account the possibility of H. influenzae.
