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Published on: December 8, 2014
Case of Pseudomembranous Colitis Caused by a Clostridioides difficile Infection Concomitant with Cytomegalovirus
Hyo Suk Kim1, Hye Min Kim1, Tae-Geun Gweon1
1Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Abstract:
A Clostridioides difficile infection (CDI) is one of the major nosocomial diarrheal diseases. Pseudomembranous colitis (PMC) is a characteristic endoscopic finding of CDI, manifested by white or yellowish plaque covering the colonic mucosa. Ischemic colitis is inflammation of the colon manifested by mucosal denudation and friability. Ischemic colitis is rarely associated with CDI. The treatment response might be delayed when CDI is complicated with other diseases that cause diarrhea. Thus far, reports of CDI concomitant with Cytomegalovirus (CMV) colitis are rare. This paper reports a case of PMC and ischemic colitis associated with CDI and CMV infection. After two weeks of oral vancomycin and intravenous metronidazole, the patient's diarrhea was not improved. Follow-up sigmoidoscopy was performed, and a CMV infection was identified at areas of broad ulceration where ischemic colitis occurred. Finally, the patient was cured with ganciclovir. Follow-up sigmoidoscopy showed an improvement in ischemic colitis.
Insights
Clostridioides difficile infection (CDI) rarely co-occurs with Cytomegalovirus (CMV) colitis and ischemic colitis. This case highlights the importance of considering co-infections for effective treatment of severe gastrointestinal conditions.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Colorectal Surgery
Background:
- Clostridioides difficile infection (CDI) is a significant cause of nosocomial diarrhea.
- Pseudomembranous colitis (PMC) is an endoscopic hallmark of CDI.
- Ischemic colitis and Cytomegalovirus (CMV) colitis are less common causes of diarrhea and can complicate CDI management.
Observation:
- A patient presented with persistent diarrhea despite standard Clostridioides difficile infection treatment.
- Endoscopic examination revealed pseudomembranous colitis and features suggestive of ischemic colitis.
- Cytomegalovirus (CMV) infection was identified in areas of ulceration associated with ischemic colitis.
Findings:
- The patient's condition did not improve with vancomycin and metronidazole, indicating a complex etiology.
- Concomitant Cytomegalovirus (CMV) colitis was diagnosed alongside Clostridioides difficile infection and ischemic colitis.
- Treatment with ganciclovir led to the resolution of CMV colitis and improvement of ischemic colitis.
Implications:
- This case underscores the diagnostic challenge posed by co-infections in severe Clostridioides difficile infection.
- Recognizing and treating concurrent Cytomegalovirus (CMV) colitis is crucial for refractory cases.
- Aggressive management of co-infections can improve outcomes in patients with complicated Clostridioides difficile infection and colitis.
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