Fact-sheet: Pseudomembranous colitis


Updated on 08/17/2020 at 3:28 PM

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Definition

Complication of broad-spectrum antibiotic therapy, frequently observed in neutropenic patients.

This antibiotic therapy allows colonization and subsequent infection with Clostridium difficile (Gram-positive, spore-forming, toxigenic strain).

Leading cause of nosocomial infectious diarrhea,
accounting for 20% of post-antibiotic diarrhea.

Clinical features

  • Greenish or cream-colored diarrhea
  • Mild fever +/- reactive arthritis

Laboratory findings

Nonspecific: leukocytosis, inflammatory syndrome.
Toxin assays are often falsely negative.

Radiography

Plain abdominal radiograph: - Mild bowel distension - Thumbprinting-like colonic wall thickening ("stack of coins" appearance) - Thumbprinting sign - Irregular colonic wall contour - Non-segmental colonic involvement

Ultrasound

- Bowel wall thickening
+/- hypoechoic pseudomembranes

CT

  • Circumferential or eccentric wall thickening, of a centimeter or more.
    This thickening is greater than in any other inflammatory or infectious colonic disease.
  • Combination of a hypodense submucosa and a hyperdense mucosa, giving the accordion sign.
  • Target or halo sign.
  • Colon often dilated, possible toxic megacolon.
  • Mild ascites

Management

Discontinuation of the causative antibiotic.

Treatment with oral metronidazole for 10 days.
Oral vancomycin and fidaxomicin are alternatives.

Rectosigmoidoscopy to visualize the pseudomembranes.

Differential diagnosis

Infectious colitis due to another organism.
Ischemic colitis