Infection with multidrug-resistant Campylobacter coli mimicking recurrence of carcinoid syndrome: a case report of a neuroendocrine tumor patient with repeated diarrhea.
Infection with multidrug-resistant Campylobacter coli mimicking recurrence of carcinoid syndrome: a case report of a neuroendocrine tumor patient with repeated diarrhea.
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DOI：
10.1186/s12879-016-1743-4
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发表时间：
2016-08-12
影响因子：
3.7
通讯作者：
Raderer M
中科院分区：
文献类型：
--
作者：
Lagler H;Kiesewetter B;Raderer M
由弯曲杆菌属革兰氏阴性菌（主要是空肠弯曲菌和大肠杆菌）引起的弯曲杆菌病是最常见的胃肠道人畜共患感染之一，在全世界人类中发病率不断增加。典型症状是严重的腹部绞痛、腹泻，有时还发烧。弯曲杆菌感染的临床病程主要是轻微的，一周后可自限，但在某些罕见情况下可能需要数周时间。然而，患有胃肠道神经内分泌肿瘤（一种肠嗜铬/神经内分泌细胞来源的肿瘤）的患者，在肿瘤生长过程中，由于肿瘤引起的激素过多，可能会出现严重腹泻。这两种疾病的临床症状非常相似，本病例报告详细阐述了它们的差异。迄今为止，文献中已知弯曲菌病的临床症状可模仿炎症性肠病的阑尾炎或急性结肠炎，但尚未报道神经内分泌肿瘤患者中类癌综合征复发的情况。一名 72 岁男性已经诊断并治疗了回肠末端转移性神经内分泌肿瘤（G1 级，Ki-67 指数 1%），但他再次出现腹泻、腹部痉挛和体重减轻的症状。这些症状与肿瘤引起的最初症状相似，在回肠末端原发灶完全切除并定期肌内注射长效缓释奥曲肽治疗后症状有所改善。当有症状的类癌综合征患者接受治疗时出现进展/快速耐受时，开始重新评估疾病和分析肿瘤标志物，并缩短肌内注射的间隔。放射学检查结果和肿瘤标志物水平没有显示神经内分泌肿瘤进展的证据，并且症状持续存在。出现症状 4 周后，患者又出现发烧症状。由于肾功能受损和全身炎症症状加重，开始补液和经验性抗菌治疗。此时进行的第一次粪便培养显示存在大肠杆菌感染。由于多重耐药分离菌株，五天后停止经验性抗菌治疗。在持续的对症治疗过程中，患者在 6 周后逐渐消失症状，导致弯曲菌病引起的症状总持续时间为 13 周。这一类似类癌综合征复发的大肠杆菌感染病例表明，对于神经内分泌肿瘤患者，尽管最初进行了成功的治疗，但症状仍在恶化，也应考虑对细菌性胃肠道感染进行评估。弯曲菌病引起的症状持续时间显着延长，这可能是由于该患者的类癌综合征引起胃肠功能障碍/粘膜变化。
Campylobacteriosis caused by Gram-negative bacteria of the genus Campylobacter (mainly C. jejuni and C. coli) is one of the most common gastrointestinal zoonotic infections with increased incidence in humans worldwide. The typical symptoms are severe abdominal cramps, diarrhea and sometimes fever. The clinical course of Campylobacter infection is mainly mild and after one week self-limiting, but can take several weeks in some rare cases. However, patients with neuroendocrine tumors in the gastrointestinal tract, a neoplasm of enterochromaffin/neuroendocrine cell origin, can develop severe diarrhea during progression of tumor growth caused by hormonal excess due to the tumor. Both diseases have very similar clinical symptoms and this case report elaborates the differences. So far it is known in the literature that the clinical symptoms of campylobacteriosis can mimic appendicitis or acute colitis of inflammatory bowel disease but a mimicking of recurrence of carcinoid syndrome in a patient with neuroendocrine tumor is not reported. A 72-year-old man with already diagnosed and treated metastatic neuroendocrine tumor of the terminal ileum (G1 rated, Ki-67 index 1 %) was again suffering from increasing diarrhea, abdominal cramps and weight lost. These symptoms were similar to the initial symptoms due to the tumor which improved at the time after total resection of the primary in the terminal ileum and regular therapy with long-acting release depot octreotide intramuscularly. As progression/tachyphylaxis in symptomatic patients with carcinoid syndrome undergoing therapy, reassessment of disease and analysis of tumor markers was initiated, and the interval of intramuscular injections was shortened. Radiological findings and tumor marker levels disclosed no evidence of neuroendocrine tumor progression and the symptoms continued. After 4 weeks with symptoms the patient developed additionally fever. Due to impaired renal function and elevated signs of systemic inflammation fluid replacement and empiric antimicrobial therapy were started. At this time-point the first stool cultures were taken which disclosed an infection with C. coli. The empiric antimicrobial therapy was stopped after five days because of multidrug-resistant isolated strain. During the ongoing symptomatic therapy the patient becomes gradually symptom-free 6 weeks later, resulting a total duration of symptoms caused by campylobacteriosis of 13 weeks. This case of infection with C. coli mimicking recurrence of carcinoid syndrome suggests that assessment for bacterial gastrointestinal infections should be taken into account also in patients with neuroendocrine tumors who present worsening of their symptoms in spite of initially successful management. The duration of symptoms caused by campylobacteriosis were significantly extended which might be due to gastroenteric dysfunctions/mucosal changes caused by the carcinoid syndrome in this patient.