Nodular colitis: endoscopic image an unusual finding

Area of Science:

• Gastroenterology
• Infectious Diseases
• Internal Medicine

Background:

• An 82-year-old male with significant comorbidities including hypertension, chronic obstructive pulmonary disease (COPD), chronic myeloid leukemia, and stage-4 chronic renal failure was hospitalized.
• The patient was admitted for treatment of lower-limb cellulitis and a severe COPD exacerbation, receiving standard antibiotic and bronchodilator therapy.

Observation:

• During hospitalization, the patient developed severe anemia and experienced hematochezia (gastrointestinal bleeding) without diarrhea.
• Colonoscopy revealed small, nacreous, elevated, circumferential lesions in the cecum and ascending colon, exhibiting bleeding stigmata and submucosal bleeding.

Findings:

• Initial findings suggested infectious colitis, but stool cultures were negative.
• However, Clostridium difficile toxins were positive, and the condition was histologically confirmed as C. difficile-associated colitis.

Implications:

• This case highlights a rare presentation of Clostridium difficile infection mimicking other colitic processes.
• It underscores the importance of considering C. difficile in patients with unexplained gastrointestinal bleeding and anemia, even without typical diarrheal symptoms.
• Early and accurate diagnosis is crucial for appropriate management and preventing complications in elderly patients with multiple comorbidities.