Community-acquired infection to Raoultella ornithinolytica presenting as appendicitis and shock in a healthy individual

Raoultella ornithinolytica and Raoultella planticola are histamine-producing bacteria that are usually found in fish and water. They are associated with scombroid syndrome that presents with vomiting and flushing. A wide range of infections with these germs is reported, but mainly in fragile hospitalized patients with multiple comorbidities. We report the case of a 54-year-old healthy patient who presented with 24-hours abdominal pain, vomiting, flushing and shock. The abdominal examination showed guarding in the right lower quadrant (RLQ), and the abdominal CT scan images showed a thickened terminal ileum and a distended appendix. The patient underwent a surgical exploration revealing a normal terminal ileum but an inflamed appendicular base. Raoultella ornithinolytica was found in blood cultures and in the liquid retrieved from the RLQ. To the best of our knowledge, this is the first report of a severe life-threatening intra-abdominal presentation due to a community-acquired R. ornithinolytica infection.