SHM Converge Scientific Abstract ePoster Gallery-A Case of the Bloody Stools: Encephalopathy and Severe Thrombocytopenia in the Setting of Bloody Diarrhea

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This case describes a 35-year-old man with HIV on Biktarvy and a history of Kaposi sarcoma who presented after a syncopal episode with a week of bloody diarrhea, fever, chills, abdominal and chest pain, shortness of breath, and tremors. On exam, he had hypotension, tachycardia, fever, facial/periorbital edema, oral thrush, abdominal tenderness, coarse breath sounds, violaceous skin lesions, and cervical lymphadenopathy.<br /><br />Laboratory testing showed severe thrombocytopenia, anemia, acute kidney injury, mild coagulopathy, metabolic acidosis, elevated phosphorus, and low complement levels. Imaging demonstrated severe proctocolitis and kidney findings concerning for acute tubular necrosis. Given the combination of bloody diarrhea, thrombocytopenia, renal dysfunction, and encephalopathy, the case was most consistent with hemolytic uremic syndrome (HUS) secondary to Shigella infection.<br /><br />The report reviews shigellosis as an invasive gram-negative diarrheal illness transmitted by the fecal-oral route. While common symptoms include fever, abdominal pain, and diarrhea, severe cases can lead to neurologic complications such as encephalopathy, as well as acute kidney injury, HUS, toxic megacolon, and reactive arthritis.<br /><br />HUS usually develops days after the onset of diarrhea and is characterized by renal injury, anemia, and bleeding risk from thrombocytopenia. Diagnosis requires strong clinical suspicion, supported by blood counts, metabolic panel, stool studies, and exclusion of other causes of microangiopathic hemolysis. Treatment is largely supportive, including fluid management, transfusion when needed, dialysis for renal failure, and cautious use of platelet transfusions. The role of plasma exchange remains uncertain.<br /><br />The key takeaway is that Shigella infection can cause life-threatening systemic complications, especially in immunocompromised patients, and early recognition with multidisciplinary management is essential to improve outcomes.

Asset Subtitle

Stewart R. Malave

Meta Tag

Author List Nathan Douthit, Stewart R. Malave

Category Clinical Vignettes

Concept Shigella Infection

Concept Hemolytic Uremic Syndrome

Concept Thrombocytopenia

Concept Anemia

Concept Renal Dysfunction

Distinguished Non-Finalist

Presenter Organization East Alabama Medical Center

Presenting Author Stewart R. Malave

Track Adult

Keywords

HIV

Biktarvy

Kaposi sarcoma

Shigella infection

bloody diarrhea

hemolytic uremic syndrome

acute kidney injury

thrombocytopenia

proctocolitis

immunocompromised

Shigella Infection

Hemolytic Uremic Syndrome

Thrombocytopenia

Anemia

Renal Dysfunction