Yersinia enterocolitica is a well-known cause of self-limited gastroenteritis, mostly in children, and can also lead to mesenteric lymphadenitis or terminal ileitis in adults. Severe infections have been reported in immunocompromised patients. We report a case of intestinal yersinia enterocolitica infection in a patient with Ulcerative Colitis (UC) on vedolizumab, an alpha4 beta7 integrin blocker, presenting as acute diarrheal illness. To our best knowledge, this is the first reported case of intestinal infection with yersinia enterocolitica with anti-integrin therapy.Case:
A 23 year-old lady who was diagnosed with ulcerative colitis with peripheral arthropathy at age 15. She was treated with anti-TNF drugs with excellent response for 6 years. She eventually lost response to treatment prompting a change to vedolizumab. Appropriate response was noted after second dose, given 3 weeks prior to her presentation. She presented to the clinic with acute watery diarrhea of one-week duration associated with intermittent hematochezia. The symptoms were also associated with vague bilateral lower abdominal pain, decreased appetite, nausea, and vomiting. She denied fevers, chills, rigors, skin rashes, recent antibiotic use or sick contacts. On exam, she was tachycardic and orthostatic. Abdominal tenderness was elicited on superficial palpation of lower quadrants. She was directly admitted to the hospital for fluid resuscitation and workup of acute severe diarrhea. She was found to have marked leukocytosis and thrombocytosis, elevated serum inflammatory markers, with otherwise normal kidney function tests. Computed Tomography (CT) of abdomen/pelvis did not show abnormal radiological enhancement or intestinal wall thickening. Stool analysis with PCR panel came back positive for Yersinia enterocolitica infection, with negative blood cultures. She was started on gentamycin and ceftriaxone with prompt response and normalization of GI symptoms. She was eventually discharged on day 3 after normalization of vital signs and inflammatory markers with oral course of Ciprofloxacin 500 mg twice daily for total of 3-week regimen, and asked to follow up with GI clinic. On a follow up visit, patient reported complete resolution of symptoms and vedolizumab was resumed without issues.Discussion:
Enteric Yersinia infection may simulate Crohn's disease, as both affect terminal ileum, and share similar histological features. Symptoms begin 4 to 7 days after exposure and may persist for as long as 1 to 3 weeks. Polymerase Chain Reaction (PCR) is the gold standard for diagnosis. Oral rehydration is the initial mode of treatment for acute gastroenteritis. Antibiotics may be required for prolonged or severe infections. Effective treatments include third-generation cephalosporins, flouroquinolones, and aminoglycosides. Our patient presented with symptoms very reminiscent of an IBD flare. Rapid infectious work up directed our treatment plan towards anti-microbial treatment instead of increase in immunosuppressive therapy. This case serves as an important reminder to rule out enteric infections as a cause of worsening symptoms. Although immunomodulatory therapies are effective in suppressing IBD symptoms, their effects on gut specific lymphocyte trafficking may render patients more prone to infections by enteric organisms such as yersinia.Methods:
This is a case report.Results:
This is a case report.Conclusions:
This is a case report.