Shigellosis Presenting as Meningism

Shigella is a common cause of gastroenteritis and can also lead to serious complications such as dehydration, seizures, hemolytic uremic syndrome, and neurological complications. In this paper, we describe a case of a 39-year-old man who was admitted septic, with altered mental status and gastrointestinal symptoms. During the evaluation, he was found to have positive meningeal signs, non-anion gap metabolic acidosis, enteric panel positive for Shigella flexneri, positive IgG for Strongyloides, and pancolitis on computed tomography (CT) of the abdomen and pelvis. He was treated for infectious colitis and initially treated empirically for meningitis, but antibiotics were later discontinued due to rapid improvement of meningeal signs. To reduce the risk of disseminated infection, the patient was also treated for Strongyloides.