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Toxic megacolon from fulminant Clostridium difficile infection induced by topical silver sulphadiazine

Christopher B Tan1, Dhyan Rajan, Mitanshu Shah

  • 1Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA. ctan@numc.edu

BMJ Case Reports
|August 11, 2012
PubMed

Insights

Topical antibiotics, like silver sulphadiazine, can rarely cause Clostridium difficile infection leading to toxic megacolon (TM). This case highlights an unusual presentation of TM without initial diarrhea.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Dermatology

Background:

  • Clostridium difficile infection (CDI) commonly leads to pseudomembranous colitis and toxic megacolon (TM).
  • Systemic antibiotics are the primary risk factor for CDI, while topical antibiotic association is rare.
  • Topical antibiotics can be systemically absorbed through damaged skin, potentially altering gut flora.

Observation:

  • A 60-year-old male with immune-bullous pemphigus vulgaris developed toxic megacolon (TM).
  • The TM was attributed to Clostridium difficile infection (CDI) triggered by topical silver sulphadiazine.
  • The patient's initial presentation lacked diarrhea, complicating the diagnosis.

Findings:

  • Topical silver sulphadiazine use was linked to the development of C. difficile-induced toxic megacolon (TM).
  • The absence of diarrhea as an initial symptom presented a diagnostic challenge.
  • Despite comprehensive medical and surgical management, the patient experienced an unfavorable outcome.

Implications:

  • This case underscores the potential for topical antibiotics to induce severe gastrointestinal complications like TM.
  • Clinicians should consider CDI in patients with toxic megacolon, even with unusual presentations or topical antibiotic exposure.
  • Further research into the systemic absorption and effects of topical antimicrobials on gut microbiota is warranted.

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