A 20-year-old college student, AJ, ate 5-day-old pasta that had been left out for two days. He experienced severe food poisoning symptoms, including vomiting, diarrhea, and abdominal pain. Despite taking stomach medicine, his condition worsened, and he was rushed to the emergency room, where he was diagnosed with liver failure. Tests revealed that AJ had hypoglycemia and high levels of liver enzymes in his blood, indicating a metabolic problem in his liver.
The medical team suspected that AJ's liver failure was caused by a toxin from the spoiled pasta. Further investigation revealed the presence of Bacillus Cereus, a type of bacteria that can cause food poisoning. However, it was also discovered that AJ had taken a stomach medicine containing bismuth subsalicylate, a salicylate that can cause liver damage when taken in excess.
The combination of the toxin cereulide from the Bacillus Cereus and the salicylate from the stomach medicine led to a dual blockade of ATP synthesis, causing AJ's liver to fail rapidly. Unfortunately, AJ did not survive, and the case highlights the importance of handling and storing food safely to prevent food poisoning.
Here are the key facts extracted from the text:
1. AJ, a 20-year-old man, presented to the emergency room with abdominal pain, nausea, and diffuse bleeding.
2. AJ had eaten 5-day-old pasta for lunch, which he had left out unrefrigerated for 2 days.
3. AJ's symptoms began immediately after eating the pasta, including stomach pain, bloating, and vomiting.
4. AJ's roommate found him passed out on the floor with a greenish-yellow complexion and called 911.
5. AJ was taken to the emergency room, where he was diagnosed with hypoglycemia (low blood sugar).
6. Blood tests revealed that AJ's liver enzymes were elevated, indicating liver damage.
7. AJ's kidneys were also failing due to acute renal injury.
8. AJ's liver failure was caused by a toxin produced by the bacteria Bacillus Cereus, which was found in the spoiled pasta.
9. The toxin, cereulide, is an ionophore that disrupts mitochondrial function, leading to liver failure.
10. AJ also took a stomach medicine containing aspirin, which further contributed to his liver failure.
11. AJ's case was a rare and severe example of food poisoning, with fulminant hepatic failure occurring within hours of presenting to the emergency room.
12. The case was presented at a grand rounds in Illinois and was used to teach residents and fellows about acute cirrhosis and hepatorenal syndrome.