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Pseudomembranous Colitis: Not Always Caused by Clostridium difficile

Derek M Tang1, Nathalie H Urrunaga1, Hannah De Groot1

  • 1Division of Gastroenterology & Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.

Case Reports in Medicine
|September 13, 2014
PubMed

Insights

Pseudomembranous colitis can stem from various causes beyond Clostridium difficile. This case shows chronic ischemia mimicking C. difficile infection, emphasizing the need for broader differential diagnoses in colitis.

Area of Science:

  • Gastroenterology
  • Colorectal Diseases
  • Pathology

Background:

  • Pseudomembranous colitis is classically attributed to Clostridium difficile.
  • However, multiple other factors, including medications, ischemia, and inflammatory conditions, can induce pseudomembrane formation.
  • Accurate diagnosis is crucial for appropriate treatment and patient outcomes.

Purpose of the Study:

  • To present a case of pseudomembranous colitis misdiagnosed as Clostridium difficile infection.
  • To highlight chronic ischemia as a potential, often overlooked, cause of pseudomembranous colitis.
  • To emphasize the importance of considering non-C. difficile etiologies in the differential diagnosis of pseudomembranous colitis.

Main Methods:

  • Case report of a middle-aged woman with vascular disease.
  • Initial diagnosis based on pseudomembrane presence, presumed to be C. difficile infection.
  • Diagnostic workup included advanced imaging, endoscopy, and detailed histopathological examination.

Main Results:

  • The patient was initially treated for refractory C. difficile infection without improvement.
  • Subsequent investigations revealed chronic ischemia as the underlying cause of colitis and pseudomembrane formation.
  • Histopathology confirmed ischemic injury rather than infectious etiology.

Conclusions:

  • Pseudomembranous colitis can arise from diverse causes, not solely C. difficile.
  • Chronic ischemia is a significant differential diagnosis for pseudomembranous colitis, particularly in patients with vascular disease.
  • Gastroenterologists must maintain a high index of suspicion for alternative etiologies to ensure correct diagnosis and management of colitis.

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