Persistent Gastrointestinal Symptoms Following Suspected Food Poisoning in a Young Woman

Case at a Glance

A 29-year-old woman presents with a one-week history of persistent gastrointestinal symptoms including diarrhea, nausea, abdominal pain, and hematochezia following suspected food poisoning, with significant weight loss and normal initial workup.

Patient's Story

The patient reported onset of symptoms on June 28th after consuming a home-cooked meal of steak, rice, and sautéed vegetables. She experienced sharp abdominal pain several hours post-meal, followed by vomiting and diarrhea beginning at 4 AM the following morning. She describes persistent nausea around food, decreased appetite requiring forced eating, and inability to complete meals. Bowel movements have remained loose to watery with multiple episodes daily. She reports intermittent sharp periumbilical pain during defecation and has noticed blood and mucus in her stool. The patient has lost 12 pounds over the course of one week.

Initial Assessment

Previously healthy 29-year-old female (BMI: 30.8, weight 163 lbs, height 5'1") with no significant gastrointestinal history. Past surgical history notable for dilation and curettage in October 2022. No current medications or known allergies. Patient appears clinically stable but reports significant functional impairment.

The Diagnostic Journey

Patient presented to emergency department after one week of symptoms due to lack of improvement and new onset hematochezia. Complete blood count, comprehensive metabolic panel, and urinalysis were within normal limits. CT scan of abdomen and pelvis showed no acute abnormalities. Stool sample demonstrated visible blood and mucus content on gross examination.

Final Diagnosis

Post-infectious gastroenteritis with prolonged course, rule out inflammatory bowel disease versus infectious colitis. Differential diagnosis includes bacterial enterocolitis (Salmonella, Campylobacter, Shigella), viral gastroenteritis with secondary complications, or early inflammatory bowel disease.

Treatment Plan

Symptomatic management with oral rehydration therapy, bland diet advancement as tolerated, and probiotic supplementation. Stool culture and ova/parasites examination ordered. Calprotectin and lactoferrin levels requested. Gastroenterology referral recommended for persistent symptoms beyond 2-3 weeks or worsening clinical picture. Patient advised to return if symptoms worsen, fever develops, or signs of dehydration occur.

Outcome and Follow-up

Patient discharged home with close primary care follow-up scheduled within 48-72 hours. Emphasis placed on maintaining adequate hydration and nutrition. Further colonoscopy evaluation may be warranted if symptoms persist beyond 4 weeks or if inflammatory markers are elevated.