Doxycycline
- PDF / 174,364 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 36 Downloads / 166 Views
S
Clostridioides difficile pseudomembranous colitis: case report A 61-year-old man developed Clostridioides difficile (C. difficile) pseudomembranous colitis following antibiotic treatment with doxycycline. The man presented to his primary care physician with 5 weeks of intermittent diarrhoea, following a hospitalisation for a new diagnosis of an underlying epilepsy less than 3 months prior. He described his stool as foul smelling, varying from loose and watery to semiformed. He noticed that some stools floated and an occasional sheen on the toilet water. He experienced average 6–12 bowel movements per day. He was experiencing nocturnal symptoms, waking up 5–6 times per night. He also reported abdominal cramp, streaks of blood in his stool and low-grade fevers at night. He reported weight loss of 20–30 pounds following his hospital discharge 3 months prior. He tried loperamide twice daily but it showed no improvement. About 3 months prior to the presentation, he had started receiving levetiracetam for an underlying epilepsy and had completed a course of doxycycline [dosage and route not stated]. There was no other antibiotic exposure. His family history was negative for inflammatory bowel disease and colon cancer. A colonoscopy 6 years prior was unremarkable. He had never smoked and drank two glasses of wine per night. On presentation, he was afebrile, normotensive, saturating well on room air and his HR was within the normal range. Preliminary investigations was found to be significant for leukocytosis, elevated CRP and mild normocytic anaemia. The stool sample sent by the primary care provider for C. difficile testing was rejected as it was too formed. He was referred for a gastroenterology consultation. The stool sample sent by the gastroenterologist for C. difficile testing was also rejected as it was too formed. Both the PCP and the gastroenterologist considered C. difficile infection as the most likely diagnosis based on the history of hospitalisation and doxycycline exposure and the temporal relationship to symptom onset. A stool community gastrointestinal PCR was found to be negative for common causes of community acquired diarrhoeal illnesses including diarrhoeagenic Escherichia coli, Campylobacter, norovirus or adenovirus. Stool ova and parasites were found to be negative. Faecal occult blood was found to be positive. Calprotectin was found to be elevated. Amylase, lipase, zinc, copper, elastase, celiac panel, ANAs, rheumatoid factor and TSH were all normal. He was scheduled for an oesophagogastroduodenoscopy (OGD) and colonoscopy with random duodenal and colon biopsies. The OGD revealed a normal stomach and duodenum, and biopsies were normal. Colonoscopy was significant for a diffuse areas of moderately congested and pseudomembrane-covered mucosa throughout the entire colon, more severe in right than left colon. Biopsies were taken with cold forceps for histology. A specimen for C. difficile was obtained from the right colon after washing the area of diffuse exudate. The specimen obtained from the right
Data Loading...
