A case report on death from acute bacterial cholangitis accompanied by von Meyenburg complexes: Use of 16S rRNA gene sequencing to identify pathogenic microbes from postmortem formalin-fixed, paraffin-embedded tissue

• Published in: Medicine (Baltimore) Vol. 100; no. 15; p. e25526
• Main Authors: Watanabe, Noriko, Ohno, Shin-ichiro, Sakuma, Moe, Kuriwaki, Mayo, Miura, Mai, Kuroda, Masahiko
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 16.04.2021
• Subjects: Acute Disease; Aged, 80 and over; Autopsy; Biliary Tract Diseases - microbiology; Cholangitis - microbiology; Clinical Case Report; Fatal Outcome; Formaldehyde; Hamartoma - microbiology; Humans; Male; Medical Illustration; Paraffin Embedding; Pseudomonas aeruginosa; RNA, Bacterial - analysis; RNA, Ribosomal, 16S - analysis; Sequence Analysis, RNA
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000025526

In some cases, autopsy is the first opportunity to find a previously unrecognized critical infection. Pathogens are identified by various methods, such as microscopic examination, special stains, culture tests, and immunohistochemistry. Here, we report a case of 16S ribosomal RNA (rRNA) gene sequencing using a postmortem formalin-fixed, paraffin-embedded (FFPE) tissue, which was useful for identifying pathogenic microbes. Autopsy was performed on an 87-year-old man who had chronic renal failure and had developed sepsis from a central venous catheter infection 10 days before his death. Prior to these events, von Meyenburg complexes (VMCs) were also found during regular checkups. Postmortem microscopic examination revealed acute purulent cholangitis with numerous microabscesses, accompanied by VMCs. Gram-negative rods were observed in some microabscesses, which were considered causative pathogens. 16S rRNA gene sequencing using postmortem FFPE tissue. Pseudomonas aeruginosa was identified, different from the one detected in the central venous catheter culture while alive. 16S rRNA gene sequencing is a useful tool for identifying pathogenic microbes in postmortem FFPE tissues. This technique may be useful for amplicon sizes of approximately 100 bp or less.