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BMJ Case Reports 2017; doi:10.1136/bcr-2016-218586
  • Unusual association of diseases/symptoms
  • CASE REPORT

An unusual case of Escherichia coli O157:H7 infection with pseudomembranous colitis-like lesions associated with haemolytic-uraemic syndrome and neurological sequelae

  1. Warren Doherty2
  1. 1Department of Intensive Care, Cheltenham General Hospital, Cheltenham, UK
  2. 2Department of Anaesthetics, Cheltenham General Hospital, Cheltenham, UK
  1. Correspondence to Dr James Kennedy, james{at}chase23.co.uk
  • Accepted 30 May 2017
  • Published 18 June 2017

Summary

A 75-year-old man was admitted with abdominal pain and fresh rectal bleeding. Significantly, he had no risk factors for Clostridium difficile infection. An abdominal CT demonstrated colonic thickening, and flexible sigmoidoscopy identified pseudomembranous colitis-like lesions. After initial treatment as C. difficile colitis, a stool sample revealed Escherichia coli O157:H7 infection. Antibiotic therapy was stopped due to the risk of lysis-mediated toxin release, but unfortunately, the patient continued to deteriorate. He developed several of the severe sequelae of E. coli O157:H7 infection, including haemolytic-uraemic syndrome with an acute kidney injury necessitating haemofiltration, plus progressively severe seizures requiring escalating antiepileptic treatment and intubation for airway protection. After a prolonged intensive care admission and subsequent recovery on the ward, our patient was discharged alive.

Footnotes

  • Contributors JK authored the majority of the text and was involved in data acquisition. LS acquired and interpreted data and wrote the investigations section. RO and WD critically revised the article and gave final approval to its publication.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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