Development of Pseudomembranous Colitis Four Months after Initiation of Rifampicin

Abstract

Pseudomembranous colitis (PMC) may develop with long-term antibiotic administration, but is rarely reported to be caused by antitubercular agents. We present a case of PMC that occurred 120 days after starting rifampicin. A 74-year-old man was diagnosed with pulmonary tuberculosis and started on a standard HERZ regimen (isoniazid, ethambutol, rifampicin, pyrazinamide). After 4 months of HERZ, he presented with frequent bloody, mucoid, jelly-like diarrhea and lower abdominal pain. Sigmoidoscopy revealed multiple whitish plaques with edematous mucosa that were compatible with PMC. Biopsies from these lesions showed ulcer-related necrotic and granulation tissue. We stopped antitubercular treatment and started the patient on oral metronidazole. His symptoms completely resolved within 2 weeks. Antitubercular treatment was restarted by replacing rifampicin with levofloxacin. The patient did not present with diarrhea or bloody stool throughout the rest of treatment.

Emergence of Clostridium difficile infection in tuberculosis patients due to a highly rifampicin-resistant PCR ribotype 046 clone in Poland

“…The emergence of rifampicin-resistant C . difficile has been reported in patients with prolonged rifampicin use [19]. In our study, all PCR ribotype 046 strains isolated from patients with prolonged rifampicin therapy were highly resistant to this drug.…”

Assessment of independent comorbidities and comorbidity measures in predicting healthcare facility-onset Clostridioides difficile infection in Kenya

“…Rifampicin was previously shown to induce CDI in patients receiving anti-tuberculosis treatment [44]. Additionally, prolonged use of rifampicin has resulted in high resistance rates in some settings, consequently promoting the persistence of resistant C. difficile strains in patients undergoing tuberculosis treatment [45,46]. In support of this, we previously reported that a large proportion of C. difficile strains isolated from the same study population showed resistance to rifampicin [9].…”

High Prevalence of Multidrug-Resistant Clostridioides difficile Following Extensive Use of Antimicrobials in Hospitalized Patients in Kenya

“…Previously, prolonged rifampicin use, especially in the treatment of TB, was implicated in the emergence of rifampicin resistance in C. difficile ( Choi et al., 2011 ). Kenya is listed by the World Health Organization (WHO) as one of the 30 high burden TB countries ( Enos et al., 2018 ).…”