A Rare Case of Campylobacter Jejuni-Associated Hepatitis

Introduction: Campylobacter species is a common culprit of bacterial diarrheal illnesses, affecting about 1.3 million patients yearly in the United States alone. Common manifestations include abdominal pain and bloody diarrhea, however certain extraintestinal manifestations can be life-threatening. We describe one such complication of campylobacter jejuni causing hepatitis in a young woman presenting with abdominal pain and diarrhea. Case Description/Methods: The patient is a 36 year old woman with a medical history of hypertension who was referred to the hepatology clinic for elevated transaminases. She was initially seen by her primary care physician for abdominal pain and diarrhea five days after eating a cheeseburger. Stool cultures were performed at that time which returned positive for Campylobacter jejuni(C. jejuni). Other notable work up included a hepatic function panel showing alanine aminotransferase (ALT) 132 u/l; aspartate aminotransferase (AST) 73 u/l; total bilirubin (T-bili) 0.5 mg/dl; and alkaline phosphatase (ALP) 89 u/l. Of note her transaminases were within normal limits 1 year prior to presentation. She was then prescribed a 3 day course of azithromyzin with subsequent improvement in her symptoms. Due to her abnormal transaminases from baseline, she was referred to hepatology clinic for further evaluation. On interview she denied alcohol use, herbal supplement use, recent travel, illicit drug use or new sexual encounters. Home medications included amlodpine daily. Viral hepatitis (hepatitis A, B, C, D, E, CMV, EBV, HSV), autoimmune hepatitis (ANA, ASMA, AMA, anti-LKM), metabolic hepatitis (ceruloplasmin, alpha-1 antitrypsin, ferritin) and celiac disease panels were all negative. Abdominal ultrasound with doppler was also done and was unremarkable. On one month follow up, her transaminases have peaked and started trending down since then. Due to her improvement after treatment, and exclusion of alternate causes of liver injury, she was diagnosed with C. jejuni associated hepatitis. Discussion: Hepatitis and other extra intestinal manifestations can be complications caused by C. jejuni. It is usually not diagnosed as it is not a part of the common workup for elevated liver enzymes. We emphasize the importance of identifying C. Jejuni in patients presenting with elevated liver enzymes and diarrhea, as early recognition and treatment with antibiotics can potentially prevent fatal complications such as acute liver failure (see Table 1). Table 1. - Laboratory trends during diagnosis and follow up ALT AST ALP T-bili Day 1 132 73 89 0.4 Day 30 375 248 73 0.5 Day 45 231 97 79 0.5 Day 70 115 49 68 0.5