Antibiotic-associated haemorrhagic colitis: not always Clostridium difficile

Area of Science:

• Gastroenterology
• Infectious Diseases
• Internal Medicine

Background:

• Antibiotic-associated colitis is a common complication of antibiotic therapy.
• Clostridium difficile colitis is the most frequent cause of antibiotic-associated colitis.
• Haemorrhagic colitis presents with bloody diarrhea and abdominal pain.

Observation:

• An 85-year-old woman presented with symptoms of severe gastrointestinal distress, including abdominal pain and mucobloody diarrhea.
• Her condition followed a 5-day course of self-initiated amoxicillin-clavulanic acid.
• Abdominal CT scan showed significant thickening of the ascending and transverse colon.

Findings:

• Stool culture confirmed the presence of Klebsiella oxytoca, a recognized cause of haemorrhagic colitis.
• The patient's symptoms improved with antibiotic cessation and conservative management.
• Colonoscopy was declined, but clinical recovery was achieved.

Implications:

• Clinicians should maintain vigilance for haemorrhagic colitis in patients using antibiotics, even when Clostridium difficile is not suspected.
• Klebsiella oxytoca should be considered as a potential pathogen in antibiotic-associated haemorrhagic colitis.
• Prompt diagnosis and management, including antibiotic withdrawal, are crucial for patient recovery.