Post-infectious vasculitis secondary to Campylobacter coli infection

Abstract

Listen

Translate article

•Vascular inflammation may be linked to Campylobacter coli infection.•Post-infectious vasculitis may cause relapsing fever after an acute infection.•18F-fluorodeoxyglucose positron emission tomography/computed tomography may be helpful for the diagnosis of post-infectious vasculitis. A 56-year-old male with no comorbidity was admitted for relapsing fever at 40°C with diarrhea and night sweats, 3 weeks after initial onset without microbiological screening in December 2020. Blood analysis showed C-reactive protein of 251.5 mg/l and negative cultures. A 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) revealed hypermetabolism highly suggestive of vasculitis affecting large and medium size arteries from upper and lower limbs, associated with highly hypermetabolic pan-colitis (Figure 1a). Stool culture was positive for Campylobacter coli. Temporal artery biopsy showed lymphocytic arteritis associated with eosinophils infiltrate, without any granuloma. A single dose of azithromycin allowed diarrhea resolution in 2 days and the inflammatory syndrome decreased after introduction of corticosteroids. The patient was treated for over 1 year, without relapse. FDG-PET/CT control after 2 years showed clear hypermetabolism regression (Figure 1b). Vascular involvements are rarely described in Campylobacter species infection but need specific follow-up to detect secondary aneurysm or stenosis. To our knowledge, diffuse vasculitis has never been previously described with Campylobacter coli [1Boissonneau S Graillon T Meyer M Brunel H Fuentes S Dufour H. Intracranial giant mycotic aneurysm without endocarditis and vasculitis: report of rare entity and review of literature.World Neurosurg. 2018; 119: 353-357https://doi.org/10.1016/j.wneu.2018.08.086Crossref PubMed Scopus (4) Google Scholar, 2Charbonnel A Carmoi T Lecoules S Bonnefoy S Algayres JP. Vascular manifestations due to Campylobacter fetus subsp. fetus infection: report of two cases.Rev Med Interne. 2012; 33: 643-645https://doi.org/10.1016/j.revmed.2012.08.011Crossref Scopus (2) Google Scholar, 3Torphy DE Bond WW. Campylobacter fetus infections in children.Pediatrics. 1979; 64: 898-903https://doi.org/10.1542/peds.64.6.898Crossref PubMed Google Scholar]. Clinical and histological findings were not suggestive of giant cell arteritis, the main differential diagnosis for large size vessels vasculitis after 50 years. FDG-PET/CT may help diagnose post-infectious vasculitis in case of relapsing fever after an acute infection. The authors have no competing interests to declare.