Abstract Introduction Severe Salmonella infections are uncommon causes of septic shock, acute respiratory distress syndrome (ARDS), and renal failure in immunocompetent hosts. We present a case of Salmonella gastroenteritis complicated by distributive shock, ARDS, and dialysis-dependent acute kidney injury (AKI) in a patient with acromegaly. Case Description A 59-year-old man with a history of acromegaly (on Somatuline Depot), hypothyroidism, and obesity presented with four days of profuse diarrhea after recent travel to Texas, where he consumed raw oysters. He reported over ten watery stools daily without hematochezia or emesis. On admission, he was tachycardic but normotensive, with WBC 17.7 ×109/L, Na 122 mmol/L, K 3.1 mmol/L, HCO3 15 mmol/L, and creatinine 10.3 mg/dL. Stool cultures grew Salmonella species.Aggressive IV fluids were initiated for severe dehydration and oliguric AKI. The patient developed worsening respiratory distress after NG tube placement with evidence of aspiration and was intubated for acute hypoxic respiratory failure. Imaging showed hepatosplenomegaly, cholelithiasis, and diverticulosis. He developed septic shock requiring norepinephrine, vasopressin, and stress-dose steroids. Continuous renal replacement therapy (CRRT) was initiated for persistent anuria and metabolic acidosis. In the ICU, he was treated with Flolan for severe ARDS and required deep sedation for ventilator synchrony.Infectious Disease recommended extended antimicrobial coverage with meropenem, inhaled tobramycin, and anidulafungin for Salmonella pneumonia complicated by pseudomonal ventilator-associated pneumonia (VAP). Despite gradual hemodynamic improvement and metabolic stabilization, attempts at ventilator liberation were unsuccessful. He failed extubation and required reintubation for bronchoscopy due to mucus plugging and refractory hypoxemia. Given poor weaning tolerance, tracheostomy and percutaneous endoscopic gastrostomy (PEG) were performed for long-term airway and nutritional support. Discussion This case demonstrates the rare progression of Salmonella gastroenteritis to multiorgan failure in an immunocompetent host. Sepsis-associated hypoperfusion and aspiration pneumonia led to ARDS and dialysis-dependent AKI. The patient’s endocrine disease and morbid obesity contributed to respiratory failure and prolonged mechanical ventilation. Conclusion Salmonella gastroenteritis can cause catastrophic systemic illness, even in immunocompetent patients. Vigilance for rapid deterioration, secondary infection, and need for advanced support (including CRRT, Flolan, and tracheostomy), is essential in severe cases. This abstract is funded by: None
Crisler et al. (Fri,) studied this question.