Intestinal bleeding and occlusion associated with Shiga toxin-producing Escherichia coli O127 : H21

We report a case of a nine-year old boy with vomiting, abdominal pain and f ever, who underwent surgery with a diagnosis of appendicitis in Mendoza and from whom a Shiga toxin-producing Escherichia cell (STEC) O127:H21 strain was recovered. Forty-eight hours after surgery he presented billous vomitin g and two episodes of intestinal bleeding. Laboratory findings included: he matocrit, 35%; blood urea nitrogen, 0.22 g/L. The urinary output was normal . The following day physical examination showed an alert mildly hydrated ch ild, without fever but with distended and painful abdomen. The patient was again submitted to surgery with a diagnosis of intestinal occlusion. Bleedi ng and multiple adhesions in jejunum and ileum were found. The patient stil l had tense and painful abdomen and presented two bowel movements with bloo d; hematocrit fell to 29% and blood urea nitrogen rose to 0.32 g/L. STEC O1 27:H21 eae(-)/Stx2/Stx2vh-b(t)/E-Hly(+) was isolated from a stool sample. H e was discharged after 10 days of hospitalization and no long-term complica tions such as HUS or TTP were observed. This is the first report, to our kn owledge, on the isolation of E. coli O127:H21, carrying the virulence facto rs that characterize STEC strains, associated to an enterohemorrhagic colit is case. This serotype was previously characterized as a non-classic entero pathogenic E. coli (EPEC). STEC infections can mimic infectious or noninfec tious pathologies. Therefore an important aspect of clinical management is making the diagnosis using different criteria thereby avoiding misdiagnoses which have occasionally led to invasive diagnostic and therapeutic procedu res or the inappropriate use of antibiotics.