North Texas Research Forum 2023
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Medical City Fort Worth
family medicine, shiga toxin, bacterial toxin, Escherichia coli, Escherichia coli infections, dysentary, cytokine release syndrome, cytokine storm, Shiga-Toxigenic Escherichia coli
Bacterial Infections and Mycoses | Family Medicine | Pathological Conditions, Signs and Symptoms
This is a unique case of a 38 year old Caucasian female with no significant medical history who presented to the hospital with complaint of 3 days of abdominal pain, nausea/vomiting, dark red formed stool, and fever (TMax 102F), as well as dizziness, body aches and throat pain. She reported eating meatloaf with her daughter two days before symptom onset, and daughter was reported to be ill as well. Upon initial exam, patient was found to have temp 100F, was hypotensive and tachycardic with lactate of 4.2. FOBT was positive. Significant lab values include creatinine 3.39 (baseline normal), hemoglobin of 11.9 and platelet count of 50. CT abdomen and pelvis showed no evidence of enterocolitis. Patient was diagnosed with severe sepsis with hypotension due to unknown source and admitted for further workup. Infectious disease, nephrology, and hematology were consulted. Initial infectious workup including blood cultures, respiratory viral panel, hepatitis panel, and HIV testing were all negative. Patient developed high fevers during course of stay, Tmax 102.9F. Patient was started on broad spectrum antibiotic coverage. Patient was unable to provide a stool sample for the first two days of admission, however on day 3 of admission patient produced a small formed dark stool which was collected for cultures. Stool cultures grew Shiga-toxin 1, leading to diagnosis of Shiga-toxin producing E. coli dysentery. Patient appeared to be in a hemolytic state based on anemia, thrombocytopenia, low haptoglobin and reticulocyte count, which along with severe renal failure on presentation suggested possibility of hemolytic-uremic syndrome (HUS). However, no schistocytes were seen on peripheral smear, therefore HUS was not diagnosed. Antibiotics were stopped, and steroids were given to treat possible cytokine storm which significantly improved patient’s fever and overall condition. Most cases of severe Shiga-toxin producing E. coli (STEC) O157H7 dysentery are seen in children and the elderly, however the infection can occur in people of all ages and range in severity. Multiple episodes of large volume bloody diarrhea is typically the major presenting symptom of STEC dysentery. A retrospective review of 32 confirmed adult cases of STEC infection in Scotland between 1997-2000 showed that 94% of cases presented with bloody diarrhea (1). Our case did not present with the classic clinical signs described above, therefore the knowledge of this atypical presentation may allow clinicians to consider the presence of dysentery even in the absence of classic symptoms, and test accordingly.
HCA Healthcare Graduate Medical Education
Roy, Diana, "Case of Shiga-Toxin Producing E. coli Dysentery in Adult Patient in the Absence of Diarrhea" (2023). North Texas Research Forum 2023. 27.
Bacterial Infections and Mycoses Commons, Family Medicine Commons, Pathological Conditions, Signs and Symptoms Commons