P4444 - Shiga-Toxin Producing E. Coli Infection in a Pregnant Patient Leading to a Diagnosis of Ulcerative Colitis: A Case Report

Kristie Liao, DO, Nathan Brott, MD, Nancy Jhanji, DO, William Oelsner, MD, Arslan Kahloon, MD
University of Tennessee Health Science Center, Chattanooga, TN

Introduction: Enterohemorrhagic E. coli (EHEC) strains are known to cause inflammatory diarrhea in humans by producing either Shiga toxin (STEC) or Shiga-like toxin (VTEC). The strain O157:H7 is responsible for outbreaks of bloody diarrhea in both resource-abundant and resource-limited areas. Patient's being actively treated for known inflammatory bowel disease are more susceptible to infections, however this case highlights a STEC infection in a pregnant individual who is later found to have newly diagnosed inflammatory bowel disease (IBD).

Case Description/Methods: A 33 year old pregnant female with a past medical history of GERD presented with fever, chills, headache, abdominal pain, and bloody diarrhea for 1 week duration. She initially had a negative infectious workup. After receiving antibiotics for two days, a GI pathogen panel resulted positive for STEC (STX1, STX2) during which antibiotics were promptly discontinued due to the high risk of hemolytic uremic syndrome (HUS). Given the persistence of her hematochezia with conservative management, a colonoscopy was performed, showing colitis. Interestingly, biopsies confirmed inflammatory bowel disease, and the patient’s symptoms rapidly improved with steroids. This particular patient’s care was complicated by her pregnancy status. She was also immunosuppressed and leukopenic due to bone marrow suppression, likely from her diarrheal illness. Fortunately, this patient did not have symptoms or lab data suggesting HUS. It is unclear if the immune dysregulation originated from the diarrheal illness and/or toxin exposure from the STEC infection, therefore increasing her risk of IBD. However, there are limited studies to support this hypothesis from this rare, unique case.

Discussion: This case highlights the importance of having a high index of suspicion for EHEC in a pregnant patient with bloody diarrhea. Even in the presence of an initially negative stool culture, the patient may have EHEC; therefore a repeat pathogen panel should be considered in the work up. Careful consideration should be given prior to the administration of antibiotics, given the risk of precipitating HUS especially in pregnancy and neutropenia. If antibiotics are started and EHEC is subsequently identified, antibiotics should be promptly discontinued. Finally, if hematochezia is persistent, the patient should be further worked up for IBD.



Disclosures:


Kristie Liao, DO, Nathan Brott, MD, Nancy Jhanji, DO, William Oelsner, MD, Arslan Kahloon, MD. P4444 - Shiga-Toxin Producing <i>E. Coli</i> Infection in a Pregnant Patient Leading to a Diagnosis of Ulcerative Colitis: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.