Diarrhea Leads to Pneumonia and Hematuria in the Intensive Care Unit

A 26-year-old man with a history of Crohn’s disease in remission presented to the Medical Intensive Care Unit with diarrhea, hematuria, left-sided pulmonary infiltrates, transaminitis, and rapid-onset respiratory failure with acute kidney injury. The patient was well until 7 days prior to admission, when he developed severe non-bloody diarrhea. Three days prior, he presented to an emergency department and was sent home after rehydration with normal saline with a reportedly normal chest x-ray. Two days prior, he presented to his primary care provider with continued diarrhea and fever to 39.4 °C, and he was sent home with antidiarrheal medications. One day prior, he returned to the emergency department with chest tightness, shortness of breath, and cough productive of dark sputum. He was found to have radiographic findings consistent with pneumonia. He also reported dark urine and anorexia, but he denied nausea, vomiting, abdominal pain, rash, or dysuria.