Ulcerative colitis is well known to be exacerbated by infections most common being bacterial and viral especially CMV, clostridium difficile and fungal infections. First recognized almost 70 years ago, 1 enterocolitis due to Staphylococcus aureus has been described as both a complication of antibiotic therapy and as occurring in individuals with predisposing conditions but no previous antibiotic treatment. We describe here a unique case of flare up of ulcerative colitis in a young amphetamine user. This was subsequently found to be due to MRSA (methicllin resistant staphylococcus aureus). He was treated successfully.
CASE REPORTA 24 year old man presented with 3 weeks history of profuse watery diarrhoea, fever and lower abdominal pain. One week before admission the stool frequency increased to 20 times/day accompanied by bleeding per rectum and vomiting. He abused amphetamine for the past 6 years. He had not travelled abroad recently and denied unprotected sexual contact. HIV and hepatitis C status was unknown and he was on no medications.Physical exam elicited temperature of 39˚C, tenderness in left iliac fossa and signs of dehydration. Haemoglobin was 10.1 g/dl (13.5-17.5 g/dl), white blood cells of 28 ×10 9 /L (4-11×10 9 /L) with neutrophilia 25.7× 10 9 /L (2.0-7.5 × 10 9 /L), CRP of 289 mg/L (0-10 mg/L), albumin was 21 g/L (35 -50 g/L). Stool cultures were negative (no clostridium difficile). Abdominal film showed 6 cm dilated transverse and descending colon.Flexible sigmoidoscopy revealed gross mucosal edema, diffuse erythema and multiple punched out ulcers in rectum and sigmoid colon (Fig A). Biopsy excluded ischemic, pseudo-membranous and CMV colitis. CT scan showed inflamed colonic wall (Fig B)
