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Fatal outcome in a child with pseudomembranous colitis
Abstract:
The clinical and histologic changes occurring with antibiotic-associated pseudomembranous colitis are usually reversible with discontinuation of the causative medication. The spectrum of disease patterns ranges from a benign form to a very fulminant and occasionally fatal one. This report describes a child with a severe form of the disease. Despite recognition and sigmoidoscopic confirmation of this syndrome and cessation of antibiotics, his course continued to deteriorate. Sepsis, leukocytosis, refractory diarrhea, and abdominal distension led to exploratory laparotomy. A proctocolectomy was performed for necrosis of the entire colon; however, the patient died of sepsis.
Insights
Antibiotic-associated pseudomembranous colitis can be severe and fatal, even after stopping antibiotics. This case highlights a child with a fulminant presentation requiring surgery but ultimately succumbing to sepsis.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Infectious Diseases
Background:
- Antibiotic-associated pseudomembranous colitis (AAPC) typically resolves upon antibiotic cessation.
- The disease spectrum ranges from mild to life-threatening.
- Fulminant AAPC in children is rare but carries significant morbidity.
Observation:
- A pediatric patient presented with severe AAPC despite early recognition and antibiotic withdrawal.
- Clinical deterioration included refractory diarrhea, abdominal distension, and leukocytosis.
- Sigmoidoscopy confirmed pseudomembranes, indicating severe colonic inflammation.
Findings:
- Despite surgical intervention (proctocolectomy) for colonic necrosis, the patient's condition worsened.
- The primary cause of mortality was sepsis, a known complication of severe AAPC.
- This case illustrates a rare, fatal outcome in pediatric AAPC.
Implications:
- Severe AAPC necessitates vigilant monitoring and aggressive management in pediatric patients.
- Early recognition and prompt treatment are crucial, but may not always prevent fatal outcomes.
- Further research into risk factors and novel therapeutic strategies for fulminant AAPC is warranted.