A0159 - Chronic Diarrhea Due to Campylobacter Infection in an Immunocompetent Host: A Case Report

Kyaw Min Tun, DO¹, Blaine Massey, DO¹, Katrina Naik, MD¹, Jose Aponte-Pieras, MD¹, Joseph Fayad, MD², Bhavana Bhaya, MD^2
1Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV; ²VA Southern Nevada Health Care System, Las Vegas, NV

Introduction: Campylobacter infection is a foodborne illness transmitted by ingestion of contaminated food or water. It is responsible for roughly 1.5 million infections annually in the U.S. Typical symptoms include acute diarrhea (< 2 weeks) that can be bloody or non-bloody, periumbilical pain, fever, and body aches. The enteritis is often self-limited in immunocompetent hosts. Subacute or chronic diarrhea can be observed in immunocompromised patients, but rarely in the immunocompetent host.

Case Description/Methods: A 58-year-old male with a history of Korsakoff syndrome and anoxic brain injury was admitted with chronic diarrhea of 2 months, severe metabolic acidosis and acute kidney injury. Patient had 5 to 6 episodes of large volume watery diarrhea daily. There was serum leukocytosis with 17.2 K/mcL. Fecal immunochemical test was negative for blood. Stool culture was positive for Campylobacter antigen. CT abdomen showed numerous mildly enlarged mesenteric root lymph nodes without pericolonic fat stranding (Figure 1). Serum and stool inflammatory markers were elevated (Table 1). Stool testing for other infectious agents was unremarkable. Diarrhea did not improve with fasting. Patient did have underlying chronic pancreatitis due to prior alcohol abuse, but had been abstinent for 3 years. He was not previously on pancreatic enzyme and vitamin supplementation, which was started but did not improve his symptoms. Screening for celiac disease, HIV, and viral hepatitis was also unremarkable. It was concluded that in addition to chronic pancreatic insufficiency, Campylobacter was the culprit for his chronic diarrhea, which was treated with IV azithromycin for 10 days. Patient’s diarrhea resolved after completion of antibiotics. Repeat CT abdomen showed near-complete resolution of previously seen lymphadenopathy.

Discussion: Chronic diarrhea due to Campylobacter infection is rare in immunocompetent hosts. Long-term Campylobacter colonization has been described in immunocompromised hosts. Colonization, or chronic campylobacteriosis, is confirmed by persistent Campylobacter-positive feces in the setting of prolonged diarrhea. It is typically treated with oral azithromycin or ciprofloxacin for 3 days. However, our patient required an intravenous administration and longer course of treatment since his symptoms were refractory to oral antibiotics. This is an uncommon case of complicated Campylobacter infection resulting in chronic diarrhea in an immunocompetent patient.




Disclosures:


Kyaw Min Tun, DO¹, Blaine Massey, DO¹, Katrina Naik, MD¹, Jose Aponte-Pieras, MD¹, Joseph Fayad, MD², Bhavana Bhaya, MD². A0159 - Chronic Diarrhea Due to Campylobacter Infection in an Immunocompetent Host: A Case Report, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.