A case of severe hemorrhagic diarrhea

A 50-year-old white female presented to the emergency department with diarrhea, abdominal pain, and hematochezia. The illness started four days prior to presentation and escalated to 10-15 bowel movements daily. She was tachycardic and hypotensive upon presentation with a diffusely tender abdomen. Her anemia and persistent hematochezia prompted endoscopy by a gastroenterologist. Flexible sigmoidoscopy was performed to the splenic flexure and revealed evidence of severe active colitis. The mucosa was friable and severely ulcerated. Numerous biopsies were obtained that revealed acute colitis with fibrinopurulent exudates. A stool culture showed Escherichia coli O157:H7, which was confirmed by the Mississippi State Board of Health. Infection with E. coli O157:H7 affects nearly 1.1 per 100,000 Americans annually. It accounts for about 3% of all bacterial and protozoal causes of foodborne illnesses and possesses a mortality rate of about 1-2%.