Cholera Sicca: A Rare and Atypical Presentation of Vibrio cholerae Infection Mimicking Bowel Obstruction

Cholera sicca is a rare and often overlooked variant of cholera, characterized by severe dehydration and circulatory collapse without the hallmark profuse diarrhea. This case report describes a 40-year-old previously healthy male who presented with abdominal distention, vomiting, and minimal bowel movements, initially mimicking bowel obstruction. The patient was hemodynamically unstable, with severe metabolic acidosis (pH 6.95), acute kidney injury (creatinine 610 µmol/L), and hypovolemia shown by a collapsed inferior vena cava on imaging. Stool studies confirmed <i>Vibrio cholerae</i> infection, leading to a diagnosis of cholera sicca. Management included aggressive fluid resuscitation, broad-spectrum antibiotics, and supportive care, resulting in clinical improvement. This case highlights the diagnostic challenges of cholera sicca, which can be misdiagnosed due to its atypical presentation. Unlike typical cholera, where profuse diarrhea facilitates early recognition, cholera sicca often presents with minimal or no diarrhea, leading to delayed treatment and higher mortality. Early recognition and aggressive fluid resuscitation are critical to improving outcomes. This report underscores the importance of considering cholera sicca in differential diagnoses, particularly in endemic regions, and emphasizes the need for enhanced diagnostic tools, such as point-of-care ultrasound, to assess volume status. Public health interventions, including improved water sanitation, mass vaccination campaigns, and healthcare worker training, are essential for preventing and managing cholera outbreaks. Cholera sicca is a life-threatening condition that requires prompt recognition and management. This case serves as a reminder of the diverse presentations of cholera and the importance of early intervention to reduce morbidity and mortality in resource-limited settings.