Breaking Down the Gut: A Case of Severe Toxin-Mediated Colitis

Abstract

Shiga-toxin-producing Escherichia coli (STEC) is a worldwide, foodborne pathogen that can lead to life-threatening complications. Transmission has been associated with undercooked meat products, contaminated food and water sources, person-to-person contact, and direct exposure to infected farm animals. As the name suggests, the major virulence factors contributing to its pathogenicity are Shiga toxins, which can cause a spectrum of clinical presentations ranging from mild watery diarrhea to severe hemorrhagic colitis due to its toxic effects on the gastrointestinal tract. We report a case of a 21-year-old man seeking medical attention due to severe crampy abdominal pain and bloody diarrhea who was ultimately diagnosed with a less commonly encountered severe form of colitis in the setting of STEC infection. Thorough investigations while maintaining a high level of clinical suspicion allowed prompt medical care with a complete resolution of symptoms. This case highlights the importance of having high clinical suspicion for STEC even with more severe forms of colitis and sheds light on the role of medical personnel in managing such cases.

Keywords: bloody diarrhea; colitis; e.coli; foodborne illness; infectious colitis.

Figure 1. Colonoscopy findings

Colonoscopy images revealed diffuse areas of severely erythematous, hemorrhagic, inflamed, and ulcerated mucosa consistent with severe colitis in the entire colon.

Figure 2. Pathology findings

Moderate to severe mucosal injury characterized by crypt atrophy and lamina propria necrosis, increased apoptotic bodies, and acute inflammation associated with erosions and necrosis suggesting the diagnosis of acute colitis.