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Antibiotic-associated hemorrhagic colitis
Abstract:
Pseudomembranous colitis arising from Clostridium difficile super-infection after treatment with various antibiotics is a well-defined portion of the pathological spectrum of antibiotic related bowel injury. We have observed two patients with hemorrhagic colitis associated with the use of penicillin derivatives. The colitis was characterized by predominant right-sided involvement, sparing of the rectum and distal colon, absence of pseudomembrane formation, and presence of marked hemorrhage in the lamina propria. Discontinuation of antibiotics resulted in prompt resolution. Early colonoscopic examination was essential in establishing the diagnosis. Follow-up examination at 9 days demonstrated complete histological and endoscopic resolution.
Insights
Penicillin derivatives can cause hemorrhagic colitis, a condition distinct from Clostridium difficile infections. Prompt diagnosis via colonoscopy and antibiotic cessation led to rapid patient recovery.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Pathology
Background:
- Antibiotic-induced bowel injury commonly presents as Clostridium difficile-associated pseudomembranous colitis.
- The spectrum of antibiotic-related pathology includes less common forms of colitis.
Observation:
- Two cases of hemorrhagic colitis linked to penicillin derivative use were identified.
- Clinical presentation included right-sided colonic inflammation with significant hemorrhage.
- Rectal and distal colon sparing, and absence of pseudomembranes were notable features.
Findings:
- Colonoscopy revealed marked hemorrhage within the lamina propria.
- Discontinuation of the causative antibiotic agent resulted in swift clinical improvement.
- Histological and endoscopic resolution was achieved within 9 days of follow-up.
Implications:
- Penicillin derivatives represent a potential cause of hemorrhagic colitis.
- Early colonoscopic diagnosis is crucial for appropriate management.
- This condition highlights the diverse gastrointestinal effects of antibiotic therapy.