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Pseudomembranous colitis: Not always Clostridium difficile
Derek M Tang1, Nathalie H Urrunaga2, Erik C von Rosenvinge2,3
1Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
Abstract:
Although Clostridium difficile infection is the cause of most cases of pseudomembranous colitis, clinicians should consider less common causes, especially if pseudomembranes are seen on endoscopy but testing remains negative for C difficile or if presumed C difficile infection does not respond to treatment. Histologic review of colonic mucosal biopsy specimens can provide clues to the underlying cause.
Insights
Pseudomembranous colitis is often caused by Clostridium difficile infection. However, consider other causes if testing is negative or treatment fails, as histology can reveal the true etiology.
Area of Science:
- Gastroenterology
- Pathology
- Infectious Diseases
Background:
- Pseudomembranous colitis is frequently associated with Clostridium difficile infection.
- Endoscopic findings of pseudomembranes warrant consideration of differential diagnoses.
Purpose of the Study:
- To highlight the importance of considering alternative etiologies of pseudomembranous colitis beyond Clostridium difficile infection.
- To emphasize the diagnostic utility of colonic mucosal biopsy histology.
Main Methods:
- Review of clinical cases presenting with pseudomembranous colitis.
- Endoscopic evaluation and C. difficile testing.
- Histologic examination of colonic mucosal biopsy specimens.
Main Results:
- Clostridium difficile infection is the most common cause of pseudomembranous colitis.
- Negative C. difficile tests or treatment non-response suggest alternative diagnoses.
- Histologic findings from biopsies can identify less common causes.
Conclusions:
- Clinicians must consider non-C. difficile causes of pseudomembranous colitis.
- Histologic review of colonic biopsies is crucial for diagnosing uncommon etiologies.
- Prompt identification of the underlying cause ensures appropriate patient management.
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