Duped by dumping syndrome: non-endemic Vibrio cholerae bacteremia in an immunocompetent host with gastric bypass surgery, a case report

Abstract

Extra-intestinal infection with non-O1/non-O139 strains of Vibrio cholerae (NOVC) is rare, though bacteremia and hepatobiliary manifestations have been reported. Reduced stomach acid, or hypochlorhydria, can increase risk of V. cholerae infection. We describe a 42-year-old woman with hypochlorhydria due to untreated Helicobacter pylori infection, gastric-bypass surgery, and chronic proton pump inhibitors (PPI) exposure, who developed acute diarrhoea following raw oyster consumption. Her symptoms were attributed to rapid gastric emptying (dumping syndrome) after a negative limited stool work-up. She had persistent diarrhoea, weight loss, and after 5 months was admitted with acute cholecystitis and NOVC bacteremia, requiring cholecystectomy. This is the first reported case of NOVC bacteremia and cholecystitis in a patient with gastric bypass. This case highlights the potential for NOVC biliary carriage, the role of hypochlorhydria as a risk factor for Vibrio infection, and the importance of excluding infectious diarrhoea in patients with new onset of symptoms compatible with dumping syndrome and a relevant travel history.

Keywords: NOVC; bacteremia; case report; gastric bypass; infectious diarrhea; non-epidemicVibrio cholerae.

Fig. 1.

Timeline of events.

Fig. 2.

A. Gram-stain of cultured organism demonstrating curved Gram-negative rods. b. Colonies on sheep blood agar. Colonies appear to be beta-hemolytic when confluent. Beta hemolysis is less apparent on sheep agar (bottom) when colonies are spread further apart. c. Lactose non-fermenting organism demonstrated (top). d. Yellow colonies on thiosulphate citrate bile salt sucrose agar (TCBS).