A Rare Case of Pseudomembrane-Associated Ulcerative Colitis

Area of Science:

• Gastroenterology
• Internal Medicine
• Pathology

Background:

• Ulcerative colitis (UC) is a chronic inflammatory bowel disease often presenting with bloody diarrhea.
• Pseudomembranes on colonoscopy are typically associated with Clostridioides difficile infection (CDI).
• Accurate diagnosis relies on clinical presentation, endoscopy, biopsy, and exclusion of other conditions.

Observation:

• A 43-year-old female presented with bloody diarrhea and pseudomembranes on colonoscopy.
• Initial Clostridioides difficile testing was inconclusive, with one positive GI pathogen panel and negative EIA for toxins.
• The patient's symptoms improved with mesalamine enemas, suggesting an alternative diagnosis.

Findings:

• Despite pseudomembranes, subsequent biopsies confirmed a diagnosis of ulcerative colitis.
• This case highlights the potential for pseudomembranes in early UC flares.
• Negative C. difficile toxin assays in the presence of pseudomembranes warrant further investigation.

Implications:

• Clinicians must consider ulcerative colitis in patients with pseudomembranes, especially with negative C. difficile toxin tests.
• Misdiagnosis can lead to delayed treatment for inflammatory bowel disease.
• This case underscores the importance of comprehensive diagnostic evaluation in complex gastrointestinal presentations.