C0431 - Recurrent Salmonella Associated With Relapse of Inflammatory Bowel Disease

Sohaib Khan, MD, Benjamin Pottebaum, DO, Kumari Piryanka, MD, Christopher Calcagno, DO, Sung Yang, MD
Parkview Medical Center, Pueblo, CO

Introduction: Inflammatory bowel disease (IBD) includes ulcerative colitis and Crohn’s disease with a clinical course comprising of multiple relapses and remissions. While numerous studies have associated clostridium difficile in IBD relapse with a prevalence of 16%, there is not much literature about the role of recurrent salmonella infection in this population.

Case Description/Methods: A 43-year-old female with history of Crohn’s disease, small bowel obstruction and multiple episodes of salmonella enteritis, presented to the hospital with persistent abdominal pain, nausea, and vomiting. Physical examination showed generalized abdominal tenderness with normal bowel sounds. A CT abdomen and pelvis revealed dilated mid jejunal loops without hyperemia, consistent with partial small bowel obstruction. Due to concerns of Crohn’s relapse, a stool PCR was ordered which was positive of salmonella. Patient as started on a fourteen-day course of cefpodoxime and was given a gastrografin challenge that relieved the obstruction as KUB after 6 hours showed contrast in the colon and patient had large bowel movements. Patient was also started on ustekinumab as she previously failed adalimumab and infliximab-abda due to formation of antibodies and recurrent salmonella enteritis. With improvement in symptoms, she was discharged with an outpatient follow up.

Discussion: Relapse of inflammatory bowel disease is described in association with various micro-organisms including campylobacter, clostridium difficile (C-difficile), shigella and salmonella. Salmonella is a facultative gram-negative anaerobic bacillus that enters the body through gastrointestinal tract and can cause various infections including enteric fever, gastroenteritis, osteomyelitis, and abscesses. Unlike C-difficile infection, very little is known about the role of recurrent salmonella in an IBD relapse. Our patient is one of the few cases with multiple relapses of Crohn’s disease due to recurrent salmonella. In case of a relapse, it is important to send stool studies early in the disease as it may prevent the unwarranted use of immunosuppressive medications and/or steroids and treating underlying infection would help fasten the recovery time. Also, it has been suggested that patients infected with non-C. Difficile infections remain in remission longer than to those infected with C. Difficile itself. With salmonella and IBD relapse, antibiotics are helpful in severe cases, but more research should be done to establish definite guidelines.


Disclosures:


Sohaib Khan, MD, Benjamin Pottebaum, DO, Kumari Piryanka, MD, Christopher Calcagno, DO, Sung Yang, MD. C0431 - Recurrent Salmonella Associated With Relapse of Inflammatory Bowel Disease, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.