Recommended Citation
Mansour M, Butler K. When Shigella Strikes: One Gut Problem Leads to Another. Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Abstract
Introduction/Background:
Uncommon in developed countries, Shigella infection can present with mild symptoms such as abdominal pain and loose stools, to severe manifestations such as hemolytic uremic syndrome and septicemia. Gastrointestinal complications can include colitis and toxic megacolon. While rarely leading to surgical complications, there are reports of acute appendicitis in children with shigellosis severe enough to lead to perforation and peritonitis. These cases have primarily been historical and seen in developing countries. We present the case of a recent immigrant who was admitted for bloody diarrhea and abdominal pain found to have shigellosis and subsequent acute appendicitis.
Description:
A 7-year-old under-immunized female who recently immigrated to the United States from Venezuela presented with two days of abdominal pain and bloody diarrhea. Initial workup included an ultrasound which was equivocal for appendicitis. A subsequent CT scan showed findings consistent with colitis and an appendix at the upper limit of normal measuring 7mm with thickened hyper-enhancing mucosa consistent with early appendicitis. A gastrointestinal pathogen panel was sent and resulted positive for Shigella species, for which treatment was initiated. Serial abdominal exams and repeat imaging remained highly concerning for acute appendicitis. She underwent laparoscopic appendectomy with pathology reporting neutrophilic inflammation compatible with acute appendicitis. She recovered well from both shigellosis colitis and associated acute appendicitis.
Discussion:
This case is a stark example of the importance of keeping a broad differential in mind throughout caring for a patient as the clinical course progresses. While Occam’s Razor poses that most symptoms can be attributed to a single cause, it is imperative to remain open-minded and avoid anchoring to a single diagnosis. While there are reported cases of shigellosis with concomitant appendicitis, most cases are historical and in developing countries. This case highlights the importance of assessing for risk factors such as recent immigration when addressing a chief complaint and initiating a diagnostic workup. Although the development of appendicitis secondary to shigellosis is rare, it is essential for providers to be acutely aware of the ongoing risk of surgical complications that may be encountered given the significant morbidity and mortality associated with delayed diagnosis, including intestinal perforation and peritonitis.
Presentation Notes
Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Full Text of Presentation
wf_yes
Document Type
Poster
When Shigella Strikes: One Gut Problem Leads to Another
Introduction/Background:
Uncommon in developed countries, Shigella infection can present with mild symptoms such as abdominal pain and loose stools, to severe manifestations such as hemolytic uremic syndrome and septicemia. Gastrointestinal complications can include colitis and toxic megacolon. While rarely leading to surgical complications, there are reports of acute appendicitis in children with shigellosis severe enough to lead to perforation and peritonitis. These cases have primarily been historical and seen in developing countries. We present the case of a recent immigrant who was admitted for bloody diarrhea and abdominal pain found to have shigellosis and subsequent acute appendicitis.
Description:
A 7-year-old under-immunized female who recently immigrated to the United States from Venezuela presented with two days of abdominal pain and bloody diarrhea. Initial workup included an ultrasound which was equivocal for appendicitis. A subsequent CT scan showed findings consistent with colitis and an appendix at the upper limit of normal measuring 7mm with thickened hyper-enhancing mucosa consistent with early appendicitis. A gastrointestinal pathogen panel was sent and resulted positive for Shigella species, for which treatment was initiated. Serial abdominal exams and repeat imaging remained highly concerning for acute appendicitis. She underwent laparoscopic appendectomy with pathology reporting neutrophilic inflammation compatible with acute appendicitis. She recovered well from both shigellosis colitis and associated acute appendicitis.
Discussion:
This case is a stark example of the importance of keeping a broad differential in mind throughout caring for a patient as the clinical course progresses. While Occam’s Razor poses that most symptoms can be attributed to a single cause, it is imperative to remain open-minded and avoid anchoring to a single diagnosis. While there are reported cases of shigellosis with concomitant appendicitis, most cases are historical and in developing countries. This case highlights the importance of assessing for risk factors such as recent immigration when addressing a chief complaint and initiating a diagnostic workup. Although the development of appendicitis secondary to shigellosis is rare, it is essential for providers to be acutely aware of the ongoing risk of surgical complications that may be encountered given the significant morbidity and mortality associated with delayed diagnosis, including intestinal perforation and peritonitis.
Affiliations
Advocate Children’s Hospital