Pseudomembranous colitis
Images in Clinical Medicine

Pseudomembranous colitis

Lei Liu1, Wei Liu2

1Institute of Digestive Disease, China Three Gorges University, Yichang, China; 2Department of Gastroenterology, Yichang Central People’s Hospital, Yichang, China

Correspondence to: Wei Liu, PhD. Institute of Digestive Disease, China Three Gorges University, 8 Daxue Road, Yichang 443000, China. Email: liuwei@ctgu.edu.cn.

Received: 27 May 2020; Accepted: 30 June 2020; Published: 25 December 2020.

doi: 10.21037/jxym-20-64


A 43-year-old man presented to the emergency department with a 3-day history of abdominal pain and diarrhea. One week before presentation, he had presented to the local community hospital with cough and fever and received the treatment of Cephalosporin. Except for paraplegia of the lower limbs, he had no documented medical history. The pulse was 74 beats per minute, and the blood pressure 123/84 mmHg. Physical examination revealed his abdomen was diffusely tender, with active bowel sounds. Laboratory tests of the blood confirmed a white-cell count of 13,300 per cubic millimeter (reference range, 4,000 to 10,000). Valuable clues were not found by computed tomography of the abdomen. On colonoscopic examination, pseudomembranous colitis (PMC) was characterized by elevated yellow-white plaques and nodules that form pseudomembranes on the mucosal surfaces of the colon (Figure 1). The diagnosis of PMC was made. PMC is a manifestation of severe colonic disease, commonly caused by Clostridium difficile infection, which is usually considered to be associated with prior antibiotic exposure and hospitalization (1-3). The clinical feature of PMC may range from a mild and non-specific diarrhea to severe colitis even with characteristics of toxic megacolon, perforation and death (4-7). Discontinuation of antibiotics and administration of oral metronidazole or vancomycin usually lead to resolution of this disease (8-10). Oral metronidazole (20 mg/kg/d) was administered for 2 weeks, and his abdominal pain and diarrhoea relieved within 1 week after treatment was initiated. No additional colonoscopy was performed after completion of the procedure. He was charged home with outpatient follow-up.

Figure 1 Pseudomembranous colitis. Colonoscopic image of yellow-white plaques and nodules forming pseudomembranes on the mucosal surfaces of the colon.

Acknowledgments

Funding: This work was supported by National Natural Science Foundation of China (31600134).


Footnote

Provenance and Peer Review: This article was a free submission to the journal. The article was sent for external peer review.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jxym-20-64). WL serves as an unpaid Academic Editor (Infectious Disease) of AME Publishing Company from Oct 2019 to Sep 2020. LL has no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Written informed consent was obtained from the patient for publication of this “Images in Clinical Medicine”.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.


References

  1. Brook I. Pseudomembranous colitis in children. J Gastroenterol Hepatol 2005;20:182-6. [Crossref] [PubMed]
  2. Farooq PD, Urrunaga NH, Tang DM, et al. Pseudomembranous colitis. Dis Mon 2015;61:181-206. [Crossref] [PubMed]
  3. Tang DM, Urrunaga NH, von Rosenvinge EC. Pseudomembranous colitis: Not always Clostridium difficile. Cleve Clin J Med 2016;83:361-6. [Crossref] [PubMed]
  4. Counihan TC, Roberts PL. Pseudomembranous colitis. Surg Clin North Am 1993;73:1063-74. [Crossref] [PubMed]
  5. Ros PR, Buetow PC, Pantograg-Brown L, et al. Pseudomembranous colitis. Radiology 1996;198:1-9. [Crossref] [PubMed]
  6. Kawaratani H, Tsujimoto T, Toyohara M, et al. Pseudomembranous colitis complicating ulcerative colitis. Dig Endosc 2010;22:373-5. [Crossref] [PubMed]
  7. Zakharova NV, Fil' TS. Pseudomembranous colitis: pathogenesis, prevention, treatment. Eksp Klin Gastroenterol 2013.87-91. [PubMed]
  8. Price AB, Davies DR. Pseudomembranous colitis. J Clin Pathol 1977;30:1-12. [Crossref] [PubMed]
  9. Moshkowitz M, Ben Baruch E, Kline Z, et al. Clinical manifestations and outcome of Pseudomembranous colitis in an elderly population in Israel. Isr Med Assoc J 2004;6:201-4. [PubMed]
  10. Kidambi TD, Chu P, Lee JK, et al. Immunotherapy-Associated Pseudomembranous Colitis. Am J Gastroenterol 2019;114:1708. [Crossref] [PubMed]
doi: 10.21037/jxym-20-64
Cite this article as: Liu L, Liu W. Pseudomembranous colitis. J Xiangya Med 2020;5:43.