Case 5

A previously healthy 32 year old man presented to an emergency room with malaise, fever, crampy abdominal pain and diarrhea x 2 days, and bloody stools x 1 day. His CBC showed a WBC of 14,000, Hgb 16.4, platelets 206,000, creatinine 0.9, LFTs normal. He had various cultures done and was given ciprofloxacin x 5 days. One week later he presented with weakness and lightheadedness, such that he had trouble getting out of bed. He had continued to note bloody stools. His temperature was 102.7 F and he was icteric. He was anemic and thrombocytopenic and was given two units of PRBC prior to transfer here. Serum creatinine was 2.2.

Past History: He had an episode of severe gastroenteritis as a child that required hospitalization. He had a peritonsillar abscess drained as an adolescent.

Medications: Vicodin p.r.n. and pantoprazole.

Family Hx: Father with cerebral aneurysm, HTN. Mother A&W. Maternal grandfather with lung CA. Maternal grandmother and paternal grandfather with MI.

Social Hx: Married, no children. Desk job. Quit smoking 3 mo ago, 2-3 beers per night. No illicit drugs. No pets.

Physical examination: Temperature 37.8 C, other vitals normal, SaO2 98% on RA. Alert and oriented. Not icteric. No focal neuro deficits. No bruises or petechiae. Exam otherwise normal.