Clostridioides difficile infection leading to fulminant colitis with toxic megacolon

Fareed Rajack; Shawn Medford; Tammey Naab

doi:10.4322/acr.2023.457

Clostridioides difficile infection leading to fulminant colitis with toxic megacolon

Autops Case Rep. 2023 Nov 16:13:e2023457. doi: 10.4322/acr.2023.457. eCollection 2023.

Authors

Fareed Rajack¹, Shawn Medford², Tammey Naab¹

Affiliations

¹ Howard University Hospital, Department of Pathology and Laboratory Medicine, Washington, D.C., United States of America.
² Howard University College of Medicine, Washington, D.C., United States of America.

Abstract

Clostridioidesdifficile infection (CDI) is the culprit of millions of nosocomial infections in the United States. Programs that successfully decrease its incidence, therefore, render cost savings for the healthcare system. Toxic megacolon and perforation are two of the most significant complications with increased mortality rates. We report a 23-year-old nursing home resident hospitalized for fever, cough, and green sputum. After 3 days of antibiotic therapy, he developed abdominal distension, diarrhea, and vomiting and underwent a total colectomy. The colon was dilated to a maximum of 11 cm with markedly edematous mucosa and yellow pseudomembranes. Qualitative PCR of the stool detected Clostridioides difficile toxin B gene. While there is no consensus for the required interval between antibiotic treatment and CDI, this presentation 3 days after starting the antibiotic therapy is earlier than most proposed ranges.

Keywords: Colectomy; Colitis; Colorectal Surgery; Diarrhea, Pseudomembranous.

Publication types

Case Reports