Case Presentation:

A 54‐year‐old man with a history of nonalcoholic steatohepatitis and hepatocellular carcinoma presented 2 months after an orthotopic liver transplant with fever and abdominal pain. Two weeks prior he had a hepatic artery thrombosis and a biliary stricture for which a hepatic artery stent and a biliary stent were placed. Laboratory workup was significant for leukocyte count of 7800/uL with 92% segmented neutrophils, hemoglobin 9.4 g/dL, alanine aminotransferase 98 units/L, aspartate aminotransferase 72 units/L, alkaline phosphatase 358 units/L, albumin 2.3 mg/dL, and total bilirubin 1.6 mg/dL. A computed tomography scan of the abdomen and pelvis revealed multiple small fluid collections in the liver consistent with bilomas. and a hepatic angiogram showed complete occlusion of the common hepatic artery stent. Two sets of blood cultures were positive for an organism initially identified by MicroScan as an alpha‐hemolytic streptococcus species. However, the identification was in question because the organism was resistant to vancomycin. Two days later, additional tests showing positive hydrolysis of esculin and arginine confirmed the organism as Weisselta confusa.


Weissella confusa is commonly found in carrot juice, sugarcane, fermented Asian foods with high acidity, Greek sausage, human peritoneal fluid, and human feces and is a rare cause of human infection. Previous reports demonstrated lactobacillemia in liver transplant patients and suggest that roux‐en‐y choledochojejunoslomy anastomosis may predispose to lactobacillemia, but that selective bowel decontamination and IV vancomycin administration do not. These reports, coupled with this case of infection in a liver transplant patient, suggest that suspicion for W confusa infection should be higher in patients with liver transplantation, abdominal surgery, and possibly recent biliary tract manipulation. Misreporting of Weisefla confusa as a Leuconostoc or lactobacillus from clinically relevant isolates may result in clinicians disregarding the bacteria or prescribing inappropriate antimicrobials for therapy. Additionally, misidentification may cause the true prevalence of Weisella confusa bacteremia and infections tc be underestimated. W. confusa should be recognized as a potential pathogen, especially in the liver transplant population, and its inherent antimicrobial resistance make accurate identification and determination of antimicrobial sensitivity paramount in prescribing appropriate antimicrobials.


This case of a monomicrobial Weisselta confusa bacteremia emphasizes the importance of proper identification of this organism to ensure Treatment with The appropriate antimicrobial Therapy. We also suggest that infection by W. confusa may be associated with bowel manipulation and abdominal surgery, especially liver transplantation.

Author Disclosure:

N. Harlan, none: R. Kempker, none; E. Burd. none; D. Kuhar, none.