A 38-year-old woman with a history of Crohn’s disease, multiple bowel resections, and ileostomy placement presented to the hospital with symptoms of increased ileostomy output for 1 week. She reported that she was emptying her bag fifteen times a day as opposed to her normal 3–4 times a day. Upon workup, she was found to have an acute kidney injury (AKI), and stool studies were positive for Cryptosporidium. She was treated with nitazoxanide 500 mg p.o. BID for 3 days along with continued rehydration. The patient was discharged after creatinine (Cr) and electrolytes returned to baseline. She continued to have elevated ileostomy output, and 1 week later, she was readmitted for another AKI and worsening of symptoms. At this hospitalization, stool studies were negative for Cryptosporidium, and the gastroenterologist consult recommended evaluation for active Crohn’s and Lomotil for possible short bowel syndrome. Eventually, her laboratory results improved, and she was discharged again before the full workup was completed. The patient’s ileostomy output continued to remain high following the second hospital discharge, and she eventually returned with another AKI, her third visit in a month. The workup for active Crohn’s was completed, with fecal calprotectin, serum cortisol, and small bowel follow-through all returning to normal. At this time, postinfectious inflammatory syndrome was suspected, and she was started on 60 mg of prednisone for 2 weeks. Steroid therapy elicited a significant response with normalization of her ileostomy output and return of laboratory results to baseline. The patient was discharged without return of symptoms at follow-up.
Case Rep Gastroenterol 2021;15:772–778

中文翻译：

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隐孢子虫感染后的感染后炎症综合征

一名 38 岁女性，有克罗恩病、多次肠切除和回肠造口术病史，因回肠造口术量增加的症状来院就诊 1 周。她报告说她每天要清空包包 15 次，而不是正常情况下每天 3-4 次。经检查，她被发现患有急性肾损伤 (AKI)，粪便检查显示隐孢子虫呈阳性。她接受了 nitazoxanide 500 mg po BID 治疗 3 天，同时继续补液。患者在肌酐 (Cr) 和电解质恢复至基线水平后出院。她的回肠造口术输出量继续升高，1 周后，她因另一次 AKI 和症状恶化再次入院。在这次住院期间，粪便研究显示隐孢子虫呈阴性，并且胃肠病学家咨询推荐的对活动性克罗恩病和 Lomotil 可能的短肠综合征的评估。最终，她的化验结果有所改善，她在全部检查完成前再次出院。在第二次出院后，患者的回肠造口术输出量继续保持高位，最终她再次出现 AKI，这是她一个月内的第三次就诊。活动性克罗恩病的检查已完成，粪便钙卫蛋白、血清皮质醇和小肠随访均恢复正常。此时怀疑感染后炎症综合征，她开始服用 60 mg 泼尼松 2 周。类固醇治疗引起了显着的反应，她的回肠造口术输出正常化并且实验室结果返回到基线。
Case Rep Gastroenterol 2021；15:772–778