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 22 April 2018

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Psuedomembranous colitis

A 77-year-old woman who developed cellulitis of her right leg whilst on holiday in Thailand. She was treated with antibiotics. Several days later she developed diarrhea and vomiting. Her symptoms persisted and 2 weeks later she returned to Adelaide, Australia, and shortly afterwards was admitted to hospital with a worsening of her symptoms.

She was taking 37.5 mg of prednisolone daily for rheumatoid lung disease. She became exquisitly tender in the left iliac fossa and a CT scan was done, looking for a localized collection. The scan showed a diffuse colitis affecting all the large bowel. A sigmoidscopy showed a patchy pseudomembrane. Clostridium difficile was isolated.

Her condition worsened and she developed a severe metabolic acidosis of 6.9. At laparotomy the transverse colon and ascending colon was hemorrhaged and ischemic. A subtotal colectomy was performed.

The photograph shows the opened specimen. The patchy pseudomembrane is evident. Histology confirmed psuedomembranous colitis.
Peter Devitt, Adelaide, Australia

Psuedomembranous colitis

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