Association of pseudomembranous colitis with Henoch-Schönlein purpura

Abstract

A 79-year-old man was admitted because of cholecystitis that occurred about 40 days after sigmoidectomy had been performed for colonic cancer. Though antibiotics improved his condition, the patient had hematochezia, diarrhea, and left lower abdominal pain. Colonoscopic findings showed multiple ring-like areas of redness and petechiae in the rectosigmoid colon and marked edema from the descending to the transverse colon. The patient then developed purpura on the extensor surfaces of the legs and bilateral gonalgia, and exacerbation of the hematochezia. A second colonoscopy (CS) showed multiple ring-like areas of redness and ecchymosis throughout the colon. The patient was diagnosed with Henoch-Schönlein purpura (HSP), and the symptoms were attenuated after the administration of prednisolone. However, diarrhea recurred in about a week; stool culture confirmed Clostridium difficile, and a third CS revealed pseudomembranes throughout the colon. The patient was diagnosed with pseudomembranous colitis (PMC), and the administration of vancomycin attenuated the symptoms. In conclusion, we have reported a rare adult case of PMC that occurred during prednisolone treatment for HSP. The PMC may have been caused by changes in the intestinal bacterial flora after the sigmoidectomy and by the intestinal lesions of HSP, as well as by the administration of antibiotics after the sigmoidectomy and for the treatment of cholecystitis, and by the use of prednisolone for the treatment of the HSP.

Gastrointestinal Manifestations of Henoch-Schonlein Purpura

“…Whether these diseases are truly linked to HSP or occur together coincidentally is unknown. Clostridium difficile-related pseudomembranous enteritis can develop with [47] or after [48] HSP. HSP may also be found in about 5% of patients with familial Mediterranean fever (FMF) with an increased frequency of the mutations associated with FMF [49].…”

Immunoglobulin A Vasculitis Complicated with Clostridium difficile Infection: a Rare Case Report and Brief Review of the Literature

“…IgA vasculitis complicated by Clostridium difficile infection (CDI) is extremely rare. To our knowledge, so far, there are only four cases in children and one in an adult published in the literature [9][10][11][12]. This makes our case the second of its type (in an adult with IgA vasculitis complicated by CDI) reported in the literature.…”

“…To the best of our knowledge, this is the second published case of IgA vasculitis complicated by CDI in adults. Upon a thorough search, we found only five cases reported so far: four children [9][10][11] and one adult [12]. The authors suggested that antibiotic therapy, intestinal lesions (mucosal ischemia) caused by IgA vasculitis and corticosteroid therapy could have led to a change in intestinal microbiota and, consequently, to overgrowth of C. difficile, increasing the risk of CDI.…”

Four Cancers and a Rash: Henoch–Schönlein Purpura

“…Then again, intestinal manifestations of Henoch-Schönlein purpura also can predispose patients to pseudomembranous colitis, so the direction of causality is uncertain. 12…”