Clinical Scenario or Case: A 46-year-old male with no known medical history presented with fatigue, abdominal pain, diarrhea, and nausea after methamphetamine use. He was febrile (101.2 °F), tachycardic, and had leukocytosis (WBC 11.7) with elevated LDH. Due to his altered state and limited communication, a thorough history was unobtainable. Physical exam and imaging guided the diagnostic process. CT abdomen/pelvis revealed findings consistent with acute colitis. He was admitted and started on IV piperacillin-tazobactam. Stool cultures ultimately confirmed Shigella sonnei.
Evidence/Literature Review: Shigella is a highly contagious enteric pathogen often associated with poor sanitation or immunocompromised states. Clinical presentations may range from mild diarrhea to severe colitis. Literature emphasizes the importance of early recognition and tailored antimicrobial therapy. According to the CDC, fluoroquinolones are first-line agents, though resistance patterns are emerging. In this case, the patient improved on empiric broad-spectrum therapy before being transitioned to oral levofloxacin for discharge.
Unique Aspects of Case: This case illustrates diagnostic challenges in patients presenting with presumed substance-related complaints. His vague presentation and social history initially obscured the infectious etiology. An osteopathic approach - treating the patient as a whole - was essential in overcoming communication barriers and avoiding diagnostic anchoring bias. Early imaging and a broad differential allowed for accurate diagnosis and treatment despite limited history.
Recommendations/Conclusions: Clinicians must avoid premature closure, especially in patients with stigmatized backgrounds such as substance use. Comprehensive evaluation using physical exam, imaging, and laboratory studies remains crucial when history is unreliable. This case underscores the value of the osteopathic philosophy: remaining holistic, open-minded, and patient-centered improves diagnostic accuracy and care outcomes.
