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Severe pseudomembranous enterocolitis in a child: case report and literature review
R J Zwiener1, W M Belknap, R Quan
1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063.
Insights
Fulminant Clostridium difficile-associated pseudomembranous enterocolitis (PMC) is a serious gastrointestinal illness in children, often triggered by antibiotics. Early recognition and treatment are crucial for recovery in this pediatric population.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Pseudomembranous enterocolitis (PMC) is an inflammatory condition caused by Clostridium difficile toxins.
- PMC is increasingly diagnosed in pediatric patients, often following antibiotic use.
- This case highlights fulminant PMC in a young child after routine antibiotic treatment.
Observation:
- A 2.5-year-old child developed severe, debilitating colitis with diarrhea, electrolyte imbalance, protein-losing enteropathy, rectal prolapse, ascites, and pleural effusion.
- The child experienced varicella and multiple disease relapses.
- Recovery required specific antimicrobial therapy and intensive supportive care.
Findings:
- Literature review identified pediatric PMC cases across all age groups, with a 20% mortality rate (9 deaths in 43 cases).
- Antibiotic therapy was associated with all but two reported pediatric PMC cases.
- Commonly implicated antibiotics include ampicillin, penicillin, cephalosporins, amoxicillin, and clindamycin.
Implications:
- PMC onset can occur during antibiotic use or up to 21 days post-discontinuation.
- Children with gastrointestinal motility disorders, like Hirschsprung's disease, are at increased risk.
- Fulminant PMC is a rare but severe complication of antibiotic therapy in children, necessitating prompt medical intervention.
Abstract:
Antibiotic-associated pseudomembranous enterocolitis (PMC), an inflammatory gastrointestinal disease mediated by toxins produced by Clostridium difficile, is increasingly recognized in the pediatric population. We report a case of fulminant PMC in an otherwise normal 2 1/2-year-old child after antibiotic therapy given for a routine childhood illness. The patient had debilitating colitis marked by severe diarrhea, a generalized electrolyte derangement, an extreme protein-losing enteropathy state, rectal prolapse, ascites, pleural effusion, varicella and multiple relapses. The child required specific antimicrobial therapy as well as aggressive supportive care to achieve recovery. A review of the literature for pediatric cases of PMC revealed reported cases in all age groups; the youngest was 5 days old. There were 9 deaths in 43 cases for a mortality rate of about 20%. All but 2 of the cases were associated with antibiotic therapy. The antibiotics most frequently implicated were ampicillin (15), penicillin (11), cephalosporins (7), amoxicillin (6) and clindamycin (5). The onset of symptoms of PMC can begin at any time while the child is taking an antibiotic or up to 21 days after it is discontinued. Children with underlying gastrointestinal motility disorders such as Hirschsprung's disease are predisposed to PMC. Fulminant PMC is a serious but uncommon infectious disease of infancy and childhood, occurring as a complication of routine antibiotic therapy for common childhood illnesses.