Campylobacter jejuni pancolitis complicated by toxic megacolon in an immunocompetent host

Abstract

This is an unusual case of a middle-aged, immunocompetent man who developed toxic megacolon (TM) secondary to infection with a normally harmless bug, Campylobacter jejuni He presented with diarrhoea, fever and abdominal pain. Faecal cultures were positive for C. jejuni However, the patient did not show significant improvement after a trial of intravenous antibiotics. Bowel segment dilation on a CT scan combined with systemic signs (fever) led to the diagnosis of TM. A subtotal colectomy was planned but an unexpected positive response to conservative therapy deferred the surgery. Our case emphasises the crucial role that bowel rest and good nutritional support play in treating TM of infectious aetiology and how it can help avoid the need for a life-altering subtotal colectomy and ileostomy. For such presentations we also highlight how empirical steroid therapy or diagnostic sigmoidoscopy for suspected underlying ulcerative colitis can be detrimental to patient outcomes.

Keywords: foodborne infections; infection (gastroenterology); inflammatory bowel disease; medical management; parenteral / enteral feeding.

Figure 1

An erythematous, non-blanching patch on the right ankle.

Figure 2

A CT image of the dilated transverse colon.