McKittrick-Wheelock syndrome complicated by Enterococcus faecalis endocarditis: a unique combination

Excerpt

A 67-year-old Caucasian male presented to the emergency room with of profuse, watery, non-bloody diarrhea for approximately the past 3 months. He described having approximately 15 bowel movements throughout all hours of the day accompanied by nausea, vomiting, and malaise. On admission, his blood pressure was 86/54, pulse rate of 80, respirations of 18, and afebrile but noted to be somnolent and pale. Digital rectal exam also revealed non-bloody watery stool. His physical examination was otherwise unremarkable. Initial laboratory tests in the emergency department revealed a sodium level of 116, potassium level of 5.5, chloride level of 67, BUN of 86, creatinine of 5.2, white blood cell count of 20.4, and hemoglobin of 14.5. Stool and Clostridium difficile studies were negative. Stool studies revealed a stool osmolar gap that supported secretory diarrhea. Chest radiograph and renal ultrasound were unremarkable. Blood cultures taken during admission tested positive for gram-positive cocci. Therefore, he was started on intravenous vancomycin and also normal saline to slowly correct the hyponatremia. The blood cultures grew Enterococcus faecalis resistant to gentamycin, and the antibiotic therapy was adjusted to ampicillin. …