Patient Encounter 4

A very pleasant 73-year-old white female with a 48-hour history of hematochezia and hemoptysis presents to the ED. She denies any recent travel, exotic foods, raw foods, or sick contacts. She does note that she ate cold-cut sandwiches at a fundraiser approximately 3 days before her symptoms started. She also noticed that she has three friends who developed bloody diarrhea who also ate at this same fundraiser. She denies any fevers, shakes, chills, cough, sore throat, shortness of breath, chest pain, nausea or vomiting, dysuria, hematuria, edema, or night sweats. On her initial presentation, she had a CT that showed pan-colitis and terminal ileitis. She was started on antibiotic therapy including ciprofloxacin and metronidazole. Fecal leukocytes were negative. A stool culture was sent and was positive for Stx. The final culture result was positive for Escherichia coli O157:H7.

What would be your next step for this patient?

Two days later, she develops acute kidney injury and thrombocytopenia. What is the most likely diagnosis?

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