P0261 - Salmonella Colitis Masquerading as Ulcerative Colitis Flare

Brandon T. Wiggins, DO, MPH¹, Blace Haviland, DO², Lina Ataya, MD³, Sonika K. Gill-Ahluwalia, DO⁴, Justin Miller, DO^5
1Ascension Genesys Hospital, Grand Blanc, MI; ²Kettering Health, Dayton, OH; ³Ascension Genesys, Flushing, MI; ⁴Ascension Genesys, Rochester Hills, MI; ⁵Ascension Genesys Hospital, Clarkston, MI

Introduction: Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by relapsing and remitting episodes of mucosal inflammation. Salmonella colitis in patients with longstanding ulcerative colitis poses a rare yet clinically significant challenge. The clinical features of UC flare and Salmonella colitis often overlap, complicating the differential diagnosis. In cases of persistent severe diarrhea despite appropriate treatment for UC, clinicians should consider the possibility of a concurrent infection.



Case Description/Methods: A 75 year old female with history of UC presented with diarrhea. The patient reported watery diarrhea every hour over the prior week without bleeding, pain or fevers.



She was diagnosed with UC 15 years prior and was controlled well on azathioprine and balsalazide without missed doses. Her last colonoscopy was 2 years prior to admission and demonstrated quiescent colitis.



Labs were remarkable for leukocytosis and elevated CRP. Urinalysis was positive for infection and she was started on antibiotics pending urine culture. Blood cultures, C. difficile, stool culture, and stool parasites were unremarkable.


Flexible sigmoidoscopy demonstrated multiple clean-based rectosigmoid ulcers that were not consistent with UC. Biopsies revealed active colitis with inflammatory changes and negative for dysplasia or viral inclusions. CT abdomen demonstrated acute descending colon colitis. Urine culture eventually returned positive for salmonella, raising suspicion for salmonella colitis and a stool PCR was pursued and positive. Ceftriaxone was switched to ciprofloxacin with resolution of symptoms and discharge.

Discussion: Salmonella is a gram-negative, facultative anaerobic Enterobacteriaceae known to cause diarrhea worldwide, as well as the leading cause of foodborne illness. Common foodborne exposures include poultry, eggs, and milk products.



Symptoms include bloody diarrhea, nausea and vomiting, fever, and possible abdominal cramping.



In a patient presenting with acute diarrhea, as seen in our case, non-typhoidal salmonella colitis is on the differential of infectious sources.The work-up of infectious colitis includes stool culture, blood culture, and/or stool PCR.



Management is often supportive due to the self limited nature in most cases. Supportive care is aimed at the replacement of fluids and electrolytes. Antibiotic therapy use is reserved for severe disease or those at risk of invasive disease, such as patients with UC.





Disclosures:


Brandon T. Wiggins, DO, MPH¹, Blace Haviland, DO², Lina Ataya, MD³, Sonika K. Gill-Ahluwalia, DO⁴, Justin Miller, DO⁵. P0261 - Salmonella Colitis Masquerading as Ulcerative Colitis Flare, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.