Fatal Edwardsiella tarda Sepsis With Acute Enlargement of Multiple Abdominal Organs on Noncontrast Computed Tomography

Edwardsiella tarda (E.tarda) is a Gram-negative bacillus found in freshwater and brackish environments.Human infection is relatively uncommon and most frequently presents as gastroenteritis, although invasive infections may occur.We report a fatal case of E. tarda sepsis with the acute enlargement of multiple abdominal organs on computed tomography (CT).A 63-year-old woman with pancreatogenic diabetes mellitus and a history of surgery for malignancies presented with abdominal pain, vomiting, diarrhea, and headache.She developed severe lactic acidosis, disseminated intravascular coagulation, and multiorgan dysfunction.Noncontrast CT demonstrated the enlargement of both kidneys and adrenal glands, as well as the liver, compared with CT images obtained approximately six months earlier; given normal renal function eight days before admission and the fulminant course, these changes were highly likely to have developed acutely.The kidneys were diffusely enlarged, with increased attenuation of the perirenal and renal sinus fat.No definite abscess, gas within the organs, or focal fluid collection was identified.Despite intensive care, multiorgan failure progressed rapidly.Blood cultures yielded E. tarda, and subsequent history-taking revealed that the patient had consumed eel on the day of symptom onset.She died of multiorgan failure on day 9 after symptom onset.This case suggests that severe E. tarda sepsis may be associated with the diffuse enlargement of multiple abdominal organs even in the absence of a localized abscess or gas-forming lesion.When no apparent focal source of infection is identified despite a clinical presentation suggestive of severe infection, prompt blood culture testing and comparison with previous imaging studies are important, and a history of seafood or freshwater fish consumption, including eel, may provide a supportive clue.