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The Diagnosis of Travelers Diarrhea Disguises an Unusual Cause of Ileus: Perforated Appendicitis Infected With Enterococcus avium

Schrödl, Kathrin MD*; Clemm, Christian MD*; Seibold, Christa MD*; Siebeck, Matthias MD; Reincke, Martin MD*

Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e31827ddec9
Case Reports
Abstract

Abstract: Travelers visiting tropical countries may contract acute infectious diarrhea with an incidence rate of 20% to 60% during a 2-week stay. Classic symptoms are diarrhea, nausea, vomiting, abdominal pain, and fever. These unspecific symptoms could also be caused by other acute illnesses, for example, appendicitis.

A 32-year-old man presented himself to our medical emergency department complaining of severe abdominal pain. The patient had returned from a skiing trip to India. One week before admission, he had liquid nonbloody diarrhea that disappeared after oral antibiotic treatment with ciprofloxacin and tinidazole. Laboratory findings revealed elevated inflammation parameters, and abdominal computed tomography showed severe small-intestinal ileus. Open laparatomy showed a gangrenous perforated appendicitis infected with Enterococcus avium as source of the symptoms.

Herein, we report an unusual—and for the clinician—very instructive case of complicated appendicitis, infected with E. avium that was at first disguised by the diagnosis of traveler’s diarrhea.

Author Information

From the *Medizinische Klinik IV and †Chirurgische Klinik Innenstadt, Ludwig-Maximilans University, Munich, Germany.

Correspondence to: Kathrin Schrödl, MD, Medizinische Klinik IV, Ludwig-Maximilians University, Ziemssenstr. 1, 80336 Munich, Germany. E-mail: kathrin.schroedl@med.uni-muenchen.de.

The authors have no funding or conflicts of interest to declare.

The manuscript has been read and approved by all authors. The patient has given written informed consent for the publication of the article.

© 2013 by Lippincott Williams & Wilkins.