P2687 - To Poop or Not to Poop That Is the Question: A Rare Case of Constipation in Campylobacter Colitis

Khaled Elsokary, DO¹, Mark P. Michael, MD¹, Osama Alshakhatreh, MD¹, Anthony Passarella, MD², Seth Richter, MD^1
1Albany Medical Center, Albany, NY; ²Albany Medical College, Albany, NY

Introduction: Campylobacter bacterial infection represents one of the most common causes of bacterial diarrheal illness and gastroenteritis worldwide, affecting approximately 23-30 per 100,000 people (1). Every year, there is about 1.3 million reported new cases in the United States. Most of cases present as self-limited diarrheal illness that last for 5-7 days. We present a rare case of CJ colitis associated with septic shock and constipation that was not improving with conventional therapy, and a FilmArray was used to aid in diagnosis and treatment.

Case Description/Methods: A 67-year-old male presented with 4 days of left lower quadrant pain, fever and constipation. He was found to have distended abdomen and septic shock necessitating vasopressor support and admission to the Intensive care unit. Computerized tomography (CT) imaging of the abdomen and pelvis showed distended colon with wall thickening of the descending and sigmoid colon, concerning for colitis. Laboratory studies were only notable for white blood cell count of 25.1 k/uL. Given the clinical findings along with the CT showing colitis, the patient was started on pipercillin and tazobactam (PT).Blood cultures showed no bacterial growth after 48 hours of incubation. A stool Biofire FilmArray GI panel was done to assess for uncommon infectious etiology given the patient’s persistent fever, lack of response to PT and lack of clear organism and was positive for CJ. The patient’s antibiotic regimen was changed to intravenous (IV) azithromycin with rapid improvement in vitals and over the subsequent 2 days he was weaned off pressors and discharged on a course of 14 days of azithromycin.

Discussion: CJ is one of the main causative organisms of gastroenteritis worldwide. In most cases infection follows consumption of undercooked poultry or contaminated food or water. The patient denied these but did note he has a new kitten at home, which studies report can carry CJ. While the clinical presentation varies, most cases present with self-limited fever and gastrointestinal symptoms such as abdominal pain and diarrhea. In very rare cases CJ colitis can present with septic shock and constipation, as in our case. With the use of a film array the rapid diagnosis and treatment of identifiable organisms allowed for early diagnosis and treatment with rapid improvement. Our case highlights the unusual presentation of CJ and the importance of film array studies to find the inciting organism and allow for both rapid treatment and early antibiotic de-escalation.


Disclosures:


Khaled Elsokary, DO¹, Mark P. Michael, MD¹, Osama Alshakhatreh, MD¹, Anthony Passarella, MD², Seth Richter, MD¹. P2687 - To Poop or Not to Poop That Is the Question: A Rare Case of Constipation in Campylobacter Colitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.