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Pseudomembranous colitis: an unusual cause of neutrocytic ascites
L Spahr1, P de Saussure, C Felley
1Division de Gastroentérologie et d'Hépatologie, Hôpital Universitaire, Geneva, Switzerland. spahr-laurent@hcuge.ch
Abstract:
Severe cases of pseudomembranous colitis (PMC) may be associated with intraperitoneal fluid accumulation. However, the characteristics of the liquid are seldom described. Specifically, neutrocytic ascites has only been reported once. We report a case of a severe PMC complicated by a highly neutrocytic ascites which remained culture-negative. We discuss the possible mechanisms leading to ascites formation in this condition and review ascitic fluid characteristics in patients with PMC.
Insights
Severe pseudomembranous colitis (PMC) can cause fluid buildup in the abdomen. This case highlights a rare instance of highly white blood cell-rich, culture-negative ascites in severe PMC.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Pathology
Background:
- Pseudomembranous colitis (PMC), often caused by Clostridium difficile, can lead to severe intra-abdominal complications.
- Intraperitoneal fluid accumulation (ascites) is a recognized, though infrequent, complication of severe PMC.
- The specific characteristics of ascitic fluid in PMC, particularly the cellular content, are not well-documented.
Observation:
- This report details a unique case of severe PMC with significant intraperitoneal fluid accumulation.
- The ascitic fluid was characterized by a markedly high concentration of neutrophils (highly neutrocytic ascites).
- Despite the high cell count, routine cultures of the ascitic fluid yielded no microbial growth.
Findings:
- The findings suggest that highly neutrocytic, culture-negative ascites can occur in severe PMC.
- This presentation challenges the typical understanding of ascites in infectious colitis, where positive cultures are often expected.
- The case underscores the heterogeneity of fluid characteristics in PMC-related ascites.
Implications:
- Understanding the nature of ascites in PMC is crucial for accurate diagnosis and management.
- Further research into the mechanisms of sterile, inflammatory ascites in PMC is warranted.
- This case may prompt clinicians to consider PMC in the differential diagnosis of unexplained neutrocytic ascites, even without positive cultures.