Azithromycin

Abstract

Pseudomembranous colitis secondary to Clostridium difficile infection following off-label use: case reportA 59-year-old woman developed pseudomembranous colitis secondary to Clostridium difficile infection during off-label therapy with azithromycin for COVID-19.The woman, who had a history of diabetes, hypertension and breast cancer post mastectomy, presented with pneumonia. She was confirmed to be COVID-19 positive. She was admitted to hospital and received off-label therapy with azithromycin [route and dosage not stated] for 6 days. On day 6 of admission, she developed constipation and started experiencing abdominal pain. On day 8 elevated WBC count was noted. Imaging revealed distension of proximal colon and caecum. Subsequently, she underwent exploratory laparotomy, which showed a necrotic appearing caecum, which had a serosal tear and was massively dilated. These findings prompted loop ileostomy with emergent hemicolectomy. Grossly caecum was dilated, black/green and thin-walled with a 5x5 yellow green raised plaques. Microscopy of the plaques showed focal erosion of colonic mucosa, with fibrin deposits, necrotic epithelial cells, mucus and overlying acute inflammatory cells, which was indicative of pseudomembranous colitis, which was further complicated by colonic pseudo-obstruction. The occurrence of pseudomembranous colitis was attributable to Clostridium difficle infection secondary to azithromycin [outcome not stated].