D0427 - Salmonella Saintpaul Colitis Mimicking Crohn's Disease

Benjamin Gow-Lee, MD¹, Phillip M. Bennett, DO², Amir M. Kashani, MD, MPH^3
1University of Utah Health, Salt Lake City, UT; ²University of Utah, Salt Lake City, UT; ³University of Utah Hospital, Salt Lake City, UT

Introduction: Salmonella are classically associated with gastroenteritis. However, Salmonella may infect the colon, potentially causing an inflammatory bowel disease (IBD) misdiagnosis. Our case presents a patient with endoscopic findings suggestive of Crohn’s disease but stool cultures positive for Salmonella Saintpaul. She had persistent disease resolution with a short course of prednisone and ciprofloxacin.

Case Description/Methods: A 22-year-old woman presented with a six-week history of abdominal pain and bloody diarrhea, along with nocturnal stooling, tenesmus, and subjective fevers. She denied recent sick contacts or personal or family history of IBD. Laboratory findings included a normal white count, mild microcytic anemia, and elevated C-reactive protein and fecal calprotectin. A colonoscopy revealed patchy inflammation in the terminal ileum and transverse colon extending to the rectum with scattered serpiginous ulcers. Histologic findings included moderate to severe active colitis throughout the colon, lacking chronic features. Stool culture grew Salmonella Saintpaul; other infectious stool studies were negative. Based on initial endoscopic findings, she was diagnosed with Crohn’s disease. The lack of histologic chronic features of inflammation was attributed to evolving disease. She was started on prednisone taper and a two-week course of ciprofloxacin. Her symptoms rapidly resolved. Initially, it was planned to start vedolizumab. However, repeat fecal calprotectin and later colonoscopy showed complete biochemical, endoscopic, and histologic remission. She remains asymptomatic 2 years later.

Discussion: Our patient’s history of a sub-acute bloody diarrhea with positive stool culture with complete disease resolution after short courses of prednisone and ciprofloxacin supports the diagnosis of Salmonella Saintpaul colitis mimicking Crohn’s disease. There have been other reports of Salmonella species mimicking Crohn’s disease, although with nonbloody diarrhea. To our knowledge, this is the first reported case of Salmonella Saintpaul mimicking Crohn’s disease. This case also presents an important treatment consideration. Based on her presumed good response to corticosteroids, vedolizumab was considered. Fortunately, her improved symptoms prompted a repeat colonoscopy showing disease resolution, sparing her from biologic treatment. Careful consideration of potential IBD mimickers and clinical presentation should be given before starting long term treatment.


Disclosures:


Benjamin Gow-Lee, MD¹, Phillip M. Bennett, DO², Amir M. Kashani, MD, MPH³. D0427 - Salmonella Saintpaul Colitis Mimicking Crohn's Disease, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.