Other medications besides antibiotics can sometimes cause pseudomembranous colitis. Chemotherapy drugs that are used to treat cancer may disrupt the normal balance of bacteria in the colon. Certain diseases that affect the colon, such as ulcerative colitis or Crohn's disease, may also predispose people to pseudomembranous colitis.
Increasingly, C. This is called community-acquired C. An aggressive strain of C. The new strain may be more resistant to certain medications and has shown up in people who haven't been in the hospital or taken antibiotics. Treatment of pseudomembranous colitis is usually successful. However, even with prompt diagnosis and treatment, pseudomembranous colitis can be life-threatening.
Possible complications include:. In addition, pseudomembranous colitis may sometimes return, days or even weeks after apparently successful treatment.
To help prevent the spread of C. If you have a friend or family member in a hospital or nursing home, don't be afraid to remind caregivers to follow the recommended precautions. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. Certain medications, chemical injury, collagenous colitis, inflammatory bowel disease, ischemia, and other infectious pathogens can reportedly cause mucosal injury and subsequent pseudomembrane formation.
We present the case of a middle-aged woman with vascular disease who was incorrectly diagnosed with refractory C. Further imaging, endoscopy, and careful histopathology review revealed chronic ischemia as the cause of her pseudomembranous colitis and diarrhea. This case highlights the need for gastroenterologists to consider non- C. Pseudomembranous colitis is commonly associated with Clostridium difficile infection CDI but can be a consequence of other disease processes.
Mucosal necrosis leads to pseudomembrane formation in both CDI and ischemia, but the two entities can be distinguished by endoscopic and histologic appearances of the colon [ 1 ]. Occlusive arterial and venous thromboemboli can cause ischemic colitis IC , but hypoperfusion without occlusion of the mesenteric or the internal iliac arteries is the main mechanism.
Patients with IC have varied presentations that depend on the onset and duration of injury and extent of involvement. Although patient risk factors, imaging, and clinical presentation can raise suspicion for colon ischemia, arteriography and colonoscopy with biopsies remain the mainstays of diagnosis. A year-old woman presented with a 3 months of diarrhea. Her past medical history was significant for peripheral vascular disease PVD , diabetes, myocardial infarction with percutaneous intervention, and ischemic cardiomyopathy.
She did not have any abdominal discomfort, blood in the stool, fever, lactic acidosis, or leukocytosis. Physical exam revealed a soft nontender and nondistended abdomen with normal bowel sounds. Initial laboratory evaluation of diarrhea showed too numerous to count fecal leukocytes and negative stool culture. Enzyme immunoassay for toxins A and B and polymerase chain reaction testing, for CDI, were repeatedly negative. Serum levels for calcitonin, chromogranin A, gastrin, serotonin, somatostatin, thyroid stimulating hormone, and vasoactive intestine peptide were within normal limits.
Urinary concentration of 5-hydroxyindoleacetic acid was unremarkable. Antibody tests for celiac disease were negative. Erythrocyte sedimentation rate and C-reactive protein were not elevated. Computed tomography CT of the abdomen and pelvis showed mild wall thickening of the distal colon with infiltration and fat stranding Figure 1. A flexible sigmoidoscopy was performed and revealed scattered and raised off-white plaques with patches of normal- appearing mucosa in the rectosigmoid colon.
The pathology revealed fibrinoid material with necrotic epithelial cells, fibrin, mucus, and neutrophils consistent with pseudomembranes. The patient was started on intravenous metronidazole for empiric treatment of CDI. Her diarrhea persisted after one week of metronidazole, and oral vancomycin was initiated. She required multiple surgical debridement procedures for necrotic skin ulcers on her lower extremities.
Anticoagulation and thrombolytic therapy were also given for treatment of a left popliteal artery thrombosis. As a result of ongoing large volume diarrhea and fecal incontinence, a repeat flexible sigmoidoscopy was completed and showed severely friable, edematous, and ulcerated mucosa involving the sigmoid colon, rectosigmoid colon, and proximal rectum Figure 2. Previously seen pseudomembranes were not visualized.
Histology was characterized primarily by crypt atrophy and lamina propria hyalinization, which supports a diagnosis of chronic ischemic colitis Figure 3. The diarrhea significantly improved with addition of loperamide.
Vascular intervention was not recommended due to poor operative candidacy, and the patient is currently being evaluated for a partial colectomy. Pseudomembranous colitis is typically associated with CDI colitis, but it has been attributed to other inflammatory and noninflammatory states.
In the literature, collagenous colitis, glutaraldehyde exposure, infectious organisms Campylobacter , cytomegalovirus, Escherichia coli H7, Salmonella , and Strongyloides , inflammatory bowel disease, ischemia, and medications nonsteroidal anti-inflammatory drugs, vasopressin have been implicated as potential causes [ 1 — 7 ]. Through similar mechanisms of endothelial damage with impaired blood flow and oxygenation, these conditions can predispose to pseudomembrane formation and can appear endoscopically and histologically similar [ 8 ].
Colon ischemia is the most common form of intestinal ischemia and usually affects the elderly or debilitated patients with multiple comorbidities [ 9 ]. IC can present as a broad spectrum of injury, from reversible submucosal or intramural colitis to irreversible chronic ulcerating colitis with stricture or gangrene [ 10 ].
A delayed diagnosis can lead to life-threatening consequences, and thus, timely diagnosis and treatment are imperative. Diagnosis of IC is based upon history, physical examination, risk factors e. The mucosa and submucosa of the colon are most susceptible to hypoxia due to high metabolic demands [ 12 ].
PMID: pubmed. Updated by: Bradley J. Editorial team. Pseudomembranous colitis. This infection is a common cause of diarrhea after antibiotic use. Health care providers in the hospital may pass this bacteria from one person to another.
Risk factors include: Older age Antibiotic use Use of medicines that weaken the immune system such as chemotherapy medicines Recent surgery History of pseudomembranous colitis History of ulcerative colitis and Crohn disease. Symptoms include: Abdominal cramps mild to severe Bloody stools Fever Urge to have a bowel movement Watery diarrhea often 5 to 10 times per day. Exams and Tests. The following tests may be done: Colonoscopy or flexible sigmoidoscopy Immunoassay for C difficile toxin in the stool Newer stool tests such as PCR.
Your provider may also suggest that you take probiotics if the infection returns. Outlook Prognosis. Possible Complications. Complications may include: Dehydration with electrolyte imbalance Perforation of hole through the colon Toxic megacolon Death. When to Contact a Medical Professional. Call your provider if you have the following symptoms: Any bloody stools especially after taking antibiotics Five or more episodes of diarrhea per day for more than 1 to 2 days Severe abdominal pain Signs of dehydration.
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