Absence of diarrhea in toxic megacolon complicating Clostridium difficile pseudomembranous colitis

We describe a patient with Clostridium difficile-associated pseudomembranous colitis who presented with toxic megacolon without diarrhea. The discussion includes a brief review of the literature, and suggests an important role for endoscopy in the diagnosis of pseudomembranous colitis and, possibly, as part of the therapy for toxic megacolon associated with Clostridium difficile colitis. The unusual combination of toxic megacolon without antecedent diarrhea should be recognized as a possible manifestation of antibiotic-associated pseudomembranous colitis, especially in the setting of simultaneous antimicrobial and opiate administration. Early diagnosis and disease-specific intervention can be lifesaving.