Acute Hepatitis and Invasive Bacteremia Caused by Aeromonas caviae in an Immunocompetent Adult: A Case Report and Literature Review.

Aeromonas spp. are emerging pathogens with recognized capacity to cause invasive infections, especially in immunocompromised hosts or in the context of environmental exposure to contaminated water. However, their clinical relevance in urban-dwelling, immunocompetent patients remains underappreciated, partly due to diagnostic challenges and lack of routine microbiological screening. We report the case of an 83-year-old immunocompetent woman, living in an urban setting, who presented with fever and altered mental status. Laboratory investigations revealed acute hepatitis with markedly elevated liver enzymes and inflammatory markers. Blood cultures identified Aeromonas caviae, resistant to carbapenems and susceptible to third-generation cephalosporins. The patient recovered with appropriate antibiotic therapy. Stool cultures were not obtained, as no gastrointestinal symptoms were present. This case highlights the potential of A. caviae to cause extraintestinal invasive disease with hepatic involvement in immunocompetent, urban-dwelling individuals. It underscores the importance of maintaining a high index of suspicion for Aeromonas spp. in febrile syndromes with liver involvement, regardless of gastrointestinal symptoms or classical exposure history. Early identification requires specific microbiological testing, which may not be routinely performed. Clinicians should consider Aeromonas spp. in the differential diagnosis of acute hepatitis and fever, even in urban settings without known environmental exposure. Failure to identify this pathogen may delay appropriate therapy and compromise outcomes. Broader awareness and targeted diagnostic strategies are warranted to improve clinical care and public health surveillance.