CT images of enterohaemorrhagic Escherichia coli colitis.

To cite: Matsunaga M, Fukahori M, Ushijima T, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015213548 DESCRIPTION A 74-year-old woman who had undergone surgery for rectal cancer and also had lung metastases developed abdominal pain, diarrhoea and bloody stools 5 days after receiving her 22nd dose of S-1, oxaliplatin and bevacizumab therapy. She was admitted to the hospital with a suspected adverse reaction to chemotherapy and infectious enteritis. CT imaging revealed marked wall-thickening that formed a three-layer structure from the caecum to the transverse colon, increased intraperitoneal adipose tissue and ascites (figure 1). Blood tests revealed a mild inflammatory response, but the patient was not anaemic and her coagulation factors were normal. She did not have a history of inflammatory bowel disease. Moreover, she had not previously received radiotherapy, nor had she been given oral administration of non-steroidal antiinflammatory drugs, steroids or antibiotics. She also had no history of overseas travel. Verotoxin was detected in the stool culture, and the diagnosis was enterohaemorrhagic colitis due to enterohaemorrhagic Escherichia coli O157. To prevent infection, it is critical to suspect E. coli O157 early in the illness when the characteristic CT findings described above are present. Learning points