The tale of the traveling cheese: Shigella in a lung transplant patient

Shigellae are Gram-negative, nonmotile, facultatively anaerobic, non-spore-forming rods. Shigella is a common cause of gastroenteritis in areas of overcrowding and poor sanitation, but is seen less frequently in the developed world. Infection is mainly acquired through the fecal-oral route, but consumption of unpasteurized dairy remains a high risk for transmission. In the developing world, Shigella is a childhood illness and with adequate hydration is fairly self-limiting. The use of antibiotics depends on the severity of illness, the age of the patient and immune status. In immunocompromised patients, chronic symptomatic or relapsing infection has been described. In this report, we describe a case of a lung transplant patient, one year out of his transplant, on triple immunosuppressive therapy, who presented with septic shock secondary to Shigella gastroenteritis after ingesting unpasteurized cheese brought back from Peru. This case highlights the importance of educating transplant patients on how to reduce certain harmful exposures that may be fatal in immunosuppressed individuals.