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STEC colitis mimicking acute severe colitis with life-threatening consequences: a case report

Journal Volume 87 - 2024
Issue Fasc.1 - Case reports
Author(s) T. Hendrickx 1, M. Peetermans 2 3, A. D’Hoore 4, K. Claes 3 5, A. Van Hootegem 6, J. Sabino 1
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Full Article
PAGES 37-39
(1) Department of Gastroenterology, UZ Leuven, Leuven, Belgium
(2) Department of General Internal Medicine, UZ Leuven, Leuven, Belgium
(3) Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
(4) Department of Abdominal Surgery, UZ Leuven, Leuven, Belgium
(5) Department of Nephrology, UZ Leuven, Leuven, Belgium
(6) Department of Gastro-enterology, AZ Klina, Brasschaat, Belgium.

Acute colitis is a common feature of infection with Shiga-toxin producing Escherichia coli (STEC) and can mimic acute severe ulcerative colitis. Early recognition is important as there is a risk of developing Shiga toxin-induced haemolytic uremic syndrome (STEC-HUS), defined by the triad of microangiopathic haemolytic anemia, thrombocytopenia and organ damage. In severe cases STEC-HUS can cause severe neurological complications and can be fatal.

Case: We present a patient with a medical history of refractory ulcerative colitis, where making the diagnosis of STEC-HUS was challenging since the initial clinical presentation was difficult to differentiate from a flare of ulcerative colitis.

Conclusion: This case illustrates that STEC induced colitis can mimic acute severe ulcerative colitis. This finding is of utmost clinical importance because of the potential life-threatening complications of STEC-HUS. Therefore it should be excluded promptly in patients with acute severe ulcerative colitis by using multiplex-PCR assay on a faecal sample.

Keywords: haemolytic uremic syndrome (HUS), thrombotic microangiopathy (TMA), ulcerative colitis (UC), inflammatory bowel disease (IBD), STEC-HUS.

© Acta Gastro-Enterologica Belgica.
PMID 38431789