Segmental haemorrhagic colitis under ciprofloxacin therapy

The segmental haemorrhagic colitis has been described as a particular form of antibiotics-associated colitis under penicillin therapy. A 34-year-old male presented in reduced general condition. He suffered from haematoschezia and abdominal pain. Due to a sinusitis maxillaris he had taken ciprofloxacin tablets (500 mg b. i. d.) for four days prior to the day of admission. Upon physical examination a slight general abdominal pain on palpation and some fresh blood at rectal digital examination were found. Apart from a slightly elevated CK level, all other routinely checked laboratory parameters were within normal ranges. All stool cultures remained negative for pathogenous germs. On colonoscopy we saw a severe haemorrhagic colitis with map-like mucosal lesions. It spread over the sigmoid and the distal part of the descending colon. The pathohistological assessment of step biopsies showed an acute erosive, ulcerative colitis. After cessation of antibiotic therapy the disorders subsided within three days without specific treatment. To the best of our knowledge a segmental haemorrhagic colitis under ciprofloxacin has not been described previously. A single Japanese paper mentions three cases of patients with a segmental haemorrhagic colitis under quinolones taken for four weeks before the symptoms started. In contrast, our patient developed symptoms within a couple of hours after intake of ciprofloxacin. We assume a toxic or idiosyncratic reaction to ciprofloxacin.