• Noriko Watanabe, Shin-Ichiro Ohno, Moe Sakuma, Mayo Kuriwaki, Mai Miura, and Masahiko Kuroda.
• Department of Molecular Pathology, Tokyo Medical University, Shinjuku-ku, Tokyo 160-8402, Japan.
• Medicine (Baltimore). 2021 Apr 16; 100 (15): e25526e25526.

RationaleIn 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.Patient ConcernsAutopsy 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.DiagnosisPostmortem 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.Interventions16S rRNA gene sequencing using postmortem FFPE tissue.OutcomesPseudomonas aeruginosa was identified, different from the one detected in the central venous catheter culture while alive.Lessons16S 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.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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