Shiga toxin-producing Escherichia coli infection-related acute encephalopathy

Shiga toxin-producing Escherichia coli (STEC) poses a significant global health threat, contributing to gastrointestinal involvement and, rarely, systemic illnesses. In particular, the toxin's pathogenic mechanisms primarily target the kidneys and the central nervous system, leading to severe consequences.

We present a rare case of STEC-related acute encephalopathy in a 34-year-old female without concurrent kidney involvement. The patient presented with hemorrhagic diarrhea and subsequent neurological symptoms, including seizures, cortical blindness, and left hemiparesis. Diagnostic evaluations, including blood tests, imaging studies, and cerebrospinal fluid analysis, suggested STEC infection-related encephalopathy.

Central nervous system involvement in STEC infections, although more commonly observed in children, can manifest in various neurological symptoms, including altered mental status, seizures, and focal neurological deficits. Neuroimaging and electrophysiological findings often demonstrate non-specific abnormalities, reflecting diffuse brain dysfunction. The pathogenesis of STEC-related encephalopathy involves direct neuronal cytotoxicity mediated by Shiga toxin, leading to acute cerebrovascular events and neuroinflammation. Therapeutic strategies primarily focus on anti-inflammatory interventions, such as high-dose steroid therapy, with variable prognosis influenced by age, sex, disease severity, and response to treatment. This case underscores the importance of recognizing STEC infection-related encephalopathy as a rare but potentially severe complication, highlighting the need for prompt diagnosis and appropriate management to optimize patient outcomes.