Photo by Chris Ware
Joanna Rodriguez of the Bronx was a healthy 26-year-old when, in mid-July 2011, she came down with what seemed like a common stomach bug. Within hours, though, she required immediate hospitalization. Her journey though the medical system illustrates just how rapidly a patient’s symptoms can exacerbate, leading to an entirely unexpected diagnosis.
“Here’s a case where, despite being managed appropriately at the beginning, the person still became very ill,” says WestMed gastroenterologist Jonathan Finegold, MD.
Rodriguez was feeling quite fatigued, the first sign that something was wrong. Then it hit: severe stomach cramps and diarrhea in the middle of a Monday night. On Tuesday evening, she headed to WestMed’s urgent-care center. Her symptoms were consistent with gastroenteritis, caused by a stomach virus. Since her vital signs were normal and nothing suggested a more serious illness might be lurking, she was advised to drink plenty of fluids to hydrate her body and to call if she felt worse. Around 3 pm the next day, she showed up in the emergency room of Montefiore Medical Center in the Bronx, with frightening new symptoms: bloody diarrhea and a fever of 101°F. A CT scan revealed that her entire colon was inflamed (a condition called pancolitis).
Rodriguez spent that afternoon and evening in the emergency room. “They immediately put me on an IV, did bloodwork, stool samples, the whole nine yards,” she says. Although the stool results were not yet available, she was released in the morning with a prescription for the antibiotic Cipro and advised to see a gastroenterologist. Later that same day, Dr. Finegold saw Rodriguez. “She had gotten worse,” he says. “Things really started to progress.” A racing pulse, low blood pressure, dehydration, and a distended abdomen told him he had to act quickly. “There was just no way she could go home. She had to be admitted.” Before firming up a diagnosis, he would have to run some tests, but, instead of lingering in the office, he had the testing done in the hospital.
“I have seen maybe one or two cases like this before in fifteen years. It’s certainly not common in Westchester.”
Rodriguez’s father rushed her to Lawrence Hospital, where a stool test revealed that she had been infected with Salmonella enteritidis. She received intravenous Cipro and fluids and was released four days later.
Salmonella lives in the intestinal tract of animals and birds and may be transmitted to humans through direct or indirect contact with their feces, according to the Centers for Disease Control and Prevention. Raw and undercooked meat and poultry, eggs, and fruits and vegetables that have not been thoroughly washed are common food sources linked to the infection. A person infected with the Salmonella bacterium typically experiences symptoms 12 to 72 hours after consuming a contaminated food or beverage. While most people recover without antibiotic treatment, sometimes symptoms are severe enough to require hospitalization. The illness is typically most severe in infants, the elderly, and people with compromised immune systems.
Being young and otherwise healthy, Rodriguez did not fit the typical profile. Symptom severity can be linked to the amount of Salmonella consumed, Dr. Finegold says, which may be why Rodriguez became so ill. A case this severe, requiring hospitalization, is rare. “I have seen maybe one or two cases like this before in fifteen years,” he says. “It’s certainly not common in Westchester.” Whatever Rodriguez ate, Dr. Finegold says, “was a seriously contaminated specimen.” While the exact source of contamination is unknown, Rodriguez suspects it may have been a salad with turkey and ham that she had purchased at a café in New Jersey three days before she sought medical attention.