An E. coli outbreak linked to romaine lettuce has turned deadly, with one person dying in California, the Centers for Disease Control and Prevention said on Wednesday.

It was the first reported death in the outbreak, which began in March and has spread to 25 states. The California Department of Public Health confirmed the death but would not provide more details, citing patient privacy laws.

The C.D.C. has recorded 121 cases nationwide, including 52 that resulted in hospitalization. Twenty-four cases have been reported in California, more than in any other state. Pennsylvania has reported 20 cases, and Idaho 11; no other state has reported more than eight.

The total provided on Wednesday is up 23 cases from the C.D.C.’s last update on April 27, and Kentucky, Massachusetts and Utah reported their first cases. The newest update includes illnesses that began as recently as April 21. It can take two to three weeks for E. coli infections to be reported to the C.D.C., so the actual case count may be higher.