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Pseudomembranous colitis is a potentially fatal disorder associated with gastrointestinal surgery and the use of antibiotics. The aetiological agent has been shown to be Clostridium difficile but the pathogenesis of the disease is unknown. It has been suggested that the lesions produced are due to a local Shwartzman effect. Such an effect may be accompanied by activation of the serum complement system and we therefore looked for evidence of complement consumption in 4 patients with the diagnostic clinical and histological features of pseudomembranous colitis. Positive evidence was obtained suggesting that a Shwartzman phenomenon may be involved.