(831) A Pediatric Case of Pneumatosis Coli With Associated Campylobacter Infection

Introduction: Campylobacter enteritis is one of the most common food-borne illnesses, often causing self-limited gastrointestinal (GI) symptoms. Mild symptoms require supportive care and in severe cases may require admission for IV rehydration and antibiotic treatment. Known GI complications of Campylobacter enteritis in pediatric patients include cholecystitis, post-infectious irritable bowel syndrome, and intestinal perforation. We present a case of an 8-year-old medically complex male with pneumatosis coli, thought to be a result of severe Campylobacter enteritis.

Description: An 8-year-old male with spastic quadriplegia, GERD, GJ-tube dependence, and epilepsy presented to the ED for evaluation of new fevers and worsening abdominal distention. He was admitted for dehydration and sepsis in the setting of Campylobacter enteritis 1 week prior. He received IV fluids and was sent home to complete a 5-day course of azithromycin. When presenting again to the ED, the patient was febrile to 100.8 F. Labs were significant for WBC 12 K/uL, Hgb 9.6 g/dL, procalcitonin 0.84 ng/mL. The urine culture was positive (80,000 CFUs/ml E. coli). Blood cultures were negative. Abdominal radiographs were suspicious for pneumatosis coli. He was conservatively managed with 7 days of bowel rest, total parental nutrition, an additional course of azithromycin, and a course of antibiotics for E. coli urinary tract infection. Pneumatosis coli resolved on subsequent radiographs and no surgical intervention was required.

Discussion: Few cases of pneumatosis coli as a complication of Campylobacter enteritis have been described and even fewer cases are noted in pediatrics. No causes of immunodeficiency were identified in our patient. However, he did have chronic proton pump inhibitor use, possibly placing him at a higher risk of severe infection. Though mortality from Campylobacter enteritis and associated complications remains low, pneumatosis coli can lead to bowel ischemia, necrosis, and perforation leading to fatal outcomes. Pneumatosis coli may be a surgical emergency and therefore must be considered in patients with acute gastroenteritis with a prolonged course of symptoms.