2024 Clinician Corner - Enterohemorrhagic Escherichia Coli: Trigger for Small Vessel Vasculitis

Abstract

We describe the case of a 19-year-old woman who presented with abdominal pain, vomiting, and a palpable purpuric rash. The patient subsequently developed dysentery and was found to have an infection from Shiga toxin–producing Escherichia coli. The patient also met diagnostic criteria for IgA vasculitis (also known as Henoch Schönlein purpura) but had negative immunofluorescence biopsies of the rash. The patient was treated with steroids and achieved recovery. To our knowledge, this is the first documented case of IgA vasculitis in the setting of an enterohemorrhagic E. coli infection. This case highlights an atypical presentation of IgA vasculitis and the need to include small vessel vasculitis as a differential diagnosis when treating patients of all ages.


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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on July 1, 2025.

Learning Objectives

After completing the article, the learner should be able to:

  • Apply the EULAR criteria to clinically diagnose IgA vasculitis
  • Identify signs and symptoms of hemolytic uremic syndrome in the setting of Shiga-toxin producing Escherichia coli
  • Be aware of clinical complications of IgA vasculitis and hemolytic uremic syndrome

Key Points: 

  • IgA Vasculitis is characterized by palpable purpura with the following possible components: abdominal pain, arthralgias, gastrointestinal bleeding, and renal complications

    • Mainstay of treatment is steroids and monitoring renal function

  • IgA positive immunofluorescence is not necessary for diagnosis of IgA vasculitis

  • Shiga-toxin producing Escherichia coli infection may result in hemolytic uremic syndrome

  • Hemolytic uremic syndrome is characterized by nonimmune hemolytic anemia, thrombocytopenia, and renal impairment

Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
07/01/2024
Course expires: 
07/01/2025
Cost:
$25.00
Rating: 
0
  • Eva Holland, BS - School of Medicine, Creighton University, Omaha, Nebraska, USA
  • Grant Koskay, BSBA - School of Medicine, Creighton University, Omaha, Nebraska, USA
  • Tiffany Chu, BS, BA - School of Medicine, Creighton University, Omaha, Nebraska, USA
  • Abubakar Tauseef, MBBS, MD - Department of Internal Medicine, Creighton University, Omaha, Nebraska, USA
  • Joseph Nahas, MD - Department of Internal Medicine, Creighton University, Omaha, Nebraska, USA
  • Venkata Andukuri, MD, MPH - Department of Internal Medicine, Creighton University, Omaha, Nebraska, USA

Corresponding Author:

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM MOC

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

 

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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