Nonspecific Erysipelothrix rhusiopathiae Bacteremia in a Patient with Subclinical Alcoholic Liver Disease

Erysipelothrix rhusiopathiae, a pleomorphic gram-positive bacillus, is found widely in nature or as a commensal pathogen. It infects domestic animals such as swine, which may be the major reservoir of the organism. E. rhusiopathiae is primarily an occupational illness; 89% of the cases are linked to high-risk epidemiological situations. Humans that are infected by this bacillus typically present with one or a combination of the following symptoms: localized skin lesion (erysipeloid), diffuse cutaneous eruptions with systemic symptoms, or bacteremia, which is often followed by endocarditis. We report a case of E. rhusiopathiae bacteremia that was present without severe clinical illness such as endocarditis, arthritis, or skin lesions. The patient was a 64-year-old male with a complicated past medical history including subclinical alcoholic liver disease. Penicillin-G therapy completely resolved the patients bacteremia. The case presented has exceptional clinical merit due to 2 key factors: the patient does not fit the occupational demographic typically affected by this bacterium, and the patient presented with subclinical septicemia, which has a high correlation with fatal endocarditis. This case brings a new prospective to E. rhusiopathiae bacteremia. 1. Introduction Erysipelothrix rhusiopathiae, a pleomorphic gram-positive bacillus, is found widely in nature or as a commensal pathogen. It infects domestic animals such as swine, which may be the major reservoir of the organism. Erysipelothrix rhusiopathiae is also found in sheep, horse, cattle, chicken, crabs, dogs, and cats and is also encrusted in fish scales for long periods. Infection in humans is mainly due to occupational exposure. Thus, abattoir workers, butchers, fishermen, farmers, and veterinarians are all at risk for infection. 2. Case A 64-year-old male presented to the emergency department at Wyckoff Heights Medical Center. The patient had a past medical history of hypertension, diabetes mellitus type 2, bronchial asthma, depression, and chronic alcoholism. The patient’s chronic alcoholism ended as per patient two weeks prior to admission. The patient denies current or previous drug abuse and tobacco abuse. Currently, the patient resides alone in a private residence where he cares for himself and has little social support. The patient previously worked at a children’s toy manufacturer. There is no history of occupational exposure to live animals; however, the patient frequently purchases his poultry and fish from markets where the animals are kept alive. He presented to the ER with