A0123 - Campylobacter jejuni: A Previously Unreported Cause of Toxic Shock Syndrome

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Glenn Garcia, Jr., MD

HCA/USF Morsani College of Medicine at HCA Florida Bayonet Point Hospital
Hudson, FL

Glenn Garcia, MD, Alexander Lake, DO, Domenick Sorresso, MD, Joseph Staffetti, MD
HCA/USF Morsani College of Medicine at HCA Florida Bayonet Point Hospital, Hudson, FL

Introduction: Campylobacter jejuni (C. jejuni) is one of the most common bacterial causes of gastroenteritis. This spirochete commonly presents as a self-resolving acute watery diarrhea; however, C. jejuni can have life-threatening sequelae - such as Guillain Barre Syndrome. We report a case of Toxic Shock Syndrome – secondary to C. jejuni.

Case Description/Methods: A 44-year-old African American female presented with shortness of breath associated with cough and weakness for 3 days. The patients' symptoms were preceded by 5 days of bloody diarrhea. She denied any chronic conditions, sick contacts, or recent travel. She works at a nursing home.
On admission, the patient wad febrile with a heart rate of 136 and respiratory rate of 22. Physical examination revealed tachypnea and diffuse abdominal tenderness and guarding. The lungs were clear to auscultation bilaterally. Chest x-ray showed no acute cardiopulmonary disease. CTA of the chest ruled out pulmonary emboli but showed a possible right lower lobe pneumonia. CT of the abdomen and pelvis was normal except for mild splenomegaly. The patient was started on intravenous (IV) fluids and treated empirically for community-acquired pneumonia.

On day 4, the patient complained of worsening lower extremity weakness and myalgia. She developed a fever to 104.9˚F (40.5˚C), hemoglobin of 6.8 g/dL, leukocytosis to 20,100 cells/mm3 , hyperbilirubinemia, and mildly elevated AST and ALT. Right upper quadrant ultrasound was normal. On exam there was a diffuse, orange rash and bilateral crackles. The patient was now requiring nonrebreather mask and was encephalopathic and hypotensive. She was intubated and transferred to the ICU.

On day 5, the patient developed purpura, thrombocytopenia, and a Nikolsky sign in the intergluteal cleft. A rectal tube was placed for hygiene, and stool cultures were obtained. Studies returned positive for C. jejuni. The patient was started on meropenem to cover for resistant strains of C. jejuni. She made a full recovery and returned to work.

Discussion: Our patient exhibited fever (104.9°F), diffuse erythrorderma, skin desquamation, hypotension and a constellation of gastrointestinal, mucosal, hepatic, and hematologic involvement. Thus, we are confident in the diagnosis of Toxic Shock Syndrome. The medical literature has only reported one case of Campylobacteriosis leading to Toxic Shock Syndrome -- caused by Campylobacter intestinalis. This is the only reported case of C. jejuni causing Toxic Shock Syndrome.

Table A: Notable Laboratory Findings
Test	Reference Range	Day 1	Day 4	Day 7	Day 10
Hemoglobin	12.0 - 18.0 g/dl	8.6 g/dL	6.8 g/dL	8.9 g/dL	9.3 g/dL
White Blood Cell Count	4 – 10.5 x 103 cells/μL	10.6 x 10³cells/μL	20.1 x 10³ cells/μL	52.6 x 10³cells/μL	28.5 x 10³cells/μL
Platelets	150-450 x 103 PLT/μL	196 x 10³ PLT/μL	74 x 10³ PLT/μL	81 x 10³ PLT/μL	73 x 10³ PLT/μL
Total Bilirubin	0.20-1.00 mg/dL	0.95 mg/dL	2.26 mg/dL	4.07 mg/dL	8.62 mg/dL
Direct Bilirubin	0.0-0.20 mg/dL	0.44 mg/dL	N/A	2.95 mg/dL	6.56 mg/dL
AST	15-37 Units/L	168 U/L	68 U/L	85 U/L	41 U/L
ALT	12-78 Units/L	128 U/L	51 U/L	42 U/L	50 U/L

Table: Table A: Notable Laboratory Findings

Disclosures:

Glenn Garcia indicated no relevant financial relationships.

Alexander Lake indicated no relevant financial relationships.

Domenick Sorresso indicated no relevant financial relationships.

Joseph Staffetti indicated no relevant financial relationships.

Glenn Garcia, MD, Alexander Lake, DO, Domenick Sorresso, MD, Joseph Staffetti, MD. A0123 - Campylobacter jejuni: A Previously Unreported Cause of Toxic Shock Syndrome, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.