SHM Converge Scientific Abstract ePoster Gallery-An Unlikely Guest With an Overstayed Welcome: Cyclospora-Induced Pi-Ibs in an Immunocompetent Host

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This case report describes a 65-year-old immunocompetent woman with three weeks of persistent, non-bloody diarrhea, abdominal tenderness, and an unrevealing initial workup including negative stool studies, C. difficile testing, COVID-19 testing, CT imaging, and colonoscopy with biopsies. Despite the absence of travel or clear exposure history, infectious disease consultation revealed that she had eaten bagged lettuce before symptom onset, raising suspicion for Cyclospora infection. Although prior Cyclospora acid-fast smear testing was negative, PCR testing later confirmed Cyclospora cayetanensis, and she was treated empirically with trimethoprim-sulfamethoxazole.<br /><br />After treatment, she was ultimately diagnosed with post-infectious irritable bowel syndrome (PI-IBS), based on ongoing abdominal discomfort, bloating, and diarrhea despite presumed clearance of the pathogen. The authors note that PI-IBS is a recognized sequela of gastrointestinal infection, but it is most commonly linked to bacterial pathogens; associations with parasites have also been reported. To their knowledge, this may be the first documented case of Cyclospora-induced PI-IBS in an immunocompetent host.<br /><br />The report emphasizes that Cyclospora should remain on the differential even in immunocompetent patients with typical symptoms, especially when there is exposure to contaminated produce. Cyclospora infection is often self-limited in immunocompetent individuals but can cause prolonged symptoms and, rarely, complications. The authors also highlight that treatment of PI-IBS is generally the same as standard IBS management, and they call for further studies to explore other interventions, including therapies that alter gut flora, for prevention and treatment.

Asset Subtitle

Trisha Jethwa

Meta Tag

Author List Matthew Aiken, Muhammad Bilal Abid, Pinky Jha, Suzanne L. Fastner, Trisha Jethwa

Category Clinical Vignettes

Concept Cyclospora infection

Concept Post-infectious irritable bowel syndrome

Concept Persistent Diarrhea

Concept Trimethoprim-sulfamethoxazole

Concept Diagnostic Workup

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Trisha Jethwa

Track Adult

Keywords

Cyclospora

Cyclospora cayetanensis

post-infectious irritable bowel syndrome

immunocompetent host

persistent diarrhea

bagged lettuce

trimethoprim-sulfamethoxazole

parasite infection

gastrointestinal infection

IBS management

Cyclospora infection

Post-infectious irritable bowel syndrome

Persistent Diarrhea

Trimethoprim-sulfamethoxazole

Diagnostic Workup