Samaha Joumana, Abdulla Hassan E, AlSubaie Renad, Albunyan Sara, AlMudayris Lina A
Department of Internal Medicine, Al Ahsa Hospital, Al Ahsa, SAU.
Department of Medicine and Surgery, King Faisal University, Al Ahsa, SAU.
Cureus. 2024 May 13;16(5):e60217. doi: 10.7759/cureus.60217. eCollection 2024 May.
() infections typically present with fever and gastrointestinal symptoms. This case report on enteritis documents atypical clinical, radiological, and endoscopic findings raising diagnostic challenges. A 31-year-old male in the Kingdom of Saudi Arabia (KSA) presented with severe abdominal pain, vomiting, bloody diarrhea, and no fever. Initial diagnosis included amebiasis and other gastroenteritis infections. Despite treatment with ciprofloxacin and metronidazole, the patient's condition did not improve, and he kept having intractable abdominal pain and vomiting. Subsequent investigations, including abdominal ultrasound and esophagogastroduodenoscopy, revealed extensive and rapidly progressive intestinal inflammation with wall thickening and ascites. Stool culture eventually identified a multidrug-resistant strain of , sensitive only to ceftriaxone. Treatment with ceftriaxone and continuous infusion of proton pump inhibitor (PPI) led to significant improvement. The absence of fever in the context of bloody diarrhea, and the rapid development of ascites not improving with first-line treatment of gastroenteritis, led to the search for other diagnoses such as inflammatory bowel syndromes or tuberculosis. The presentation of diffuse intestinal wall thickening with intractable vomiting, bloody diarrhea, and progressively increasing ascites is not frequently encountered with . The case also underscores the growing concern of antibiotic-resistant strains. The patient's response to targeted antibiotic therapy emphasizes the importance of accurate microbial identification and susceptibility testing in managing infectious diseases. This case report illustrates an atypical presentation of enteritis with progressively increasing ascites and increased intestinal wall thickening. The uncommon complicated clinical picture led to challenges in diagnosis and management. It emphasizes the need for high clinical suspicion and comprehensive diagnostic approaches in atypical cases of common infections, especially in the context of increasing antibiotic resistance.
（）感染通常表现为发热和胃肠道症状。本份关于肠炎的病例报告记录了非典型的临床、放射学和内镜检查结果，给诊断带来了挑战。一名31岁的沙特阿拉伯王国男性患者出现严重腹痛、呕吐、血性腹泻且无发热症状。初步诊断包括阿米巴病和其他肠胃炎感染。尽管使用环丙沙星和甲硝唑进行了治疗，但患者的病情并未改善，仍持续有顽固性腹痛和呕吐症状。随后的检查，包括腹部超声和食管胃十二指肠镜检查，显示出广泛且迅速进展的肠道炎症，伴有肠壁增厚和腹水。粪便培养最终鉴定出一种多重耐药的 菌株，仅对头孢曲松敏感。使用头孢曲松治疗并持续输注质子泵抑制剂（PPI）后病情显著改善。在血性腹泻的情况下无发热，且腹水迅速发展，一线肠胃炎治疗无效，这促使人们寻找其他诊断，如炎症性肠病综合征或结核病。弥漫性肠壁增厚伴顽固性呕吐、血性腹泻和腹水逐渐增加的表现，在 感染中并不常见。该病例还凸显了对抗生素耐药 菌株日益增长的担忧。患者对靶向抗生素治疗的反应强调了准确的微生物鉴定和药敏试验在管理传染病中的重要性。本病例报告说明了肠炎的非典型表现，伴有腹水逐渐增加和肠壁增厚加剧。这种罕见的复杂临床表现给诊断和管理带来了挑战。它强调了在常见感染的非典型病例中，尤其是在抗生素耐药性增加的情况下，需要高度的临床怀疑和全面的诊断方法。
