Abstract
A 54-year-old bedridden Japanese man with a history of cerebral infarction and recurrent cholecystitis that required
biliary stenting was admitted with fever and vomiting shortly after treatment for aspiration pneumonia. He showed
signs of sepsis, and laboratory tests revealed leukocytosis, elevated C-reactive protein, and abnormal liver function.
Blood cultures grew Shewanella algae and Enterococcus faecalis. Abdominal CT confirmed a biliary stent without
signs of abscess or ileus. ERCP revealed sludge-induced stent obstruction. The stent was replaced, and papillotomy
was performed. Bile cultures confirmed the same organisms. Although the patient had had no exposure to seawater,
he had consumed a small amount of raw fish approximately one month prior to onset. He improved with meropenem
and was discharged in stable condition. This case highlights Shewanella algae as an emerging pathogen in
healthcare-associated biliary infections and suggests that even remote dietary exposure may be relevant in such infections.
