Enterohemorrhagic Esherichia Coli Infection: An Atypical Presentation

Abstract

Purpose: Introduction: Enterohemorrhagic Eschericia coli (EHEC) is a common bacterial pathogen which is typically transmitted from the feces of healthy cattle to humans through contaminated food, water and direct contact. Infection is characterized by a wide range of clinical features from asymptomatic shedding to hemorrhagic colitis, hemolytic uremic syndrome and death. Intussusception in the pediatric population is typically idiopathic however, in adults it is usually secondary to other processes. We present the case of intussusception caused by EHEC infection in an adult. Case: A 20-year-old African-American female with no past medical history presents with a two day history of crampy, abdominal pain which began with mild nausea, vomiting, and bloody diarrhea. CT performed on admission revealed right sided colitis and terminal ileitis as well as intussusception of small bowel. Initial colonoscopic examination revealed ischemic cecum and ascending colon, biopsies were performed which revealed changes consistent with early ischemic colitis. Stool cultures performed on admission grew E. coli 0157 with discontinuation of empiric antibiotics and clinical resolution of gastrointestinal symptoms. The patient experienced no complications and was discharged in stable condition without further sequelae. Discussion: Enterohemorrhagic E. coli (EHEC) is the most common causative pathogen isolated in dysenteric illness in the U.S. A unique feature of EHEC are the Shiga toxins which enter the systemic circulation, are bound to polymorphonuclear leukocytes and target endothelial cells leading to vascular damage and ultimately bloody diarrhea. Whereas intussusception in the pediatric population is usually idiopathic, in adults it is typically secondary to processes such as Meckel's diverticulum, masses or polyps, lymphomas, inflammatory bowel disease, and infections. In this case, we suspect the enteric immune response possibly led to lymphoid hyperplasia and a focus precipitating intussusception. This is a rare case of an enterohemorrhagic E. coli infection presenting with intussusception and is an important finding for clinicians to be aware of when evaluating patients presenting with abdominal pain and bloody diarrhea.Figure