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Perforated pseudomembranous colitis in the breast-fed infant
T Harmon1, G Burkhart, H Applebaum
1Department of Surgery, Kaiser Foundation Hospital, Los Angeles, CA. 90027.
Insights
A rare case of infant pseudomembranous colitis (PMC) occurred after the mother took antibiotics while breastfeeding. This highlights the risk of breast milk antibiotic transmission causing infant Clostridium difficile infection.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Medicine
- Infectious Diseases
Background:
- Pseudomembranous colitis (PMC) is a rare condition in infants, with surgical complications being even rarer.
- Previous cases of infant PMC involved direct antibiotic administration to the child.
Observation:
- A 2-month-old infant underwent bowel resection due to a perforated, thickened, and inflamed left colon.
- The infant's stool tested positive for Clostridium difficile toxin, consistent with PMC.
- The infant recovered after treatment with vancomycin.
Findings:
- The infant's mother reported self-administering ciprofloxacin while breastfeeding.
- Ciprofloxacin is known to concentrate in breast milk at levels exceeding maternal serum.
- Antibiotics transmitted via breast milk can lead to complicated PMC in infants.
Implications:
- A targeted patient history is crucial for diagnosing infant PMC.
- This case underscores the importance of considering maternal medication use in infant enterocolitis.
- Distinguishing PMC from other infantile enterocolitides is vital for appropriate management.
Abstract:
Pseudomembranous colitis (PMC) is uncommon in the infant and complications requiring surgical intervention are rare. All prior cases have involved the direct administration of antibiotics to the child. A 2-month-old girl required bowel resection for perforation of a thickened and inflamed left colon. Findings were consistent with PMC and the stool was Clostridium difficile toxin positive. The patient was treated with vancomycin and did well. The patient's mother later admitted to self-administration of ciprofloxacin while breast-feeding her infant. Oral doses of this drug are concentrated in breast milk at levels higher than serum. Antibiotics derived from breast milk can cause complicated PMC in the infant. A directed history can establish an early diagnosis and help distinguish PMC from other more common infantile enterocolitides.