Fulminant Pseudomembranous Colitis Presenting as Sigmoid Stricture and Severe Polyposis with Clinical Response to Intracolonic Vancomycin

Abstract

Clostridium difficile infection (CDI) is the most common cause of antibiotic-associated diarrhea. Severe diseases carry significant morbidities such as septic shock, acute kidney injury, bowel perforation, and mortality. Immunocompromising conditions increase the risk of developing the disease but whether these individuals suffer a more fulminant course or warrant a more potent first-line treatment is still controversial issue. Hereby we report a case of a cirrhotic patient with life-threatening pseudomembranous colitis complicated by colonic stricture, initially refractory to standard treatment but with subsequent improvement on intracolonic vancomycin.

Intracolonic Administration of Vancomycin in Intensive Care Unit Patients with Severe Clostridium Difficile Colitis

“…CDI was first reported in 1978, and its incidence, recurrence, and virulence are on the rise [ 10 ]. It is established that CDI increases the cost of hospitalizations and raises the incidence of readmissions.…”

Combination of oral vancomycin and intra-colonic vancomycin: Successful treatment of complicated pseudomembranous colitis in a child patient

“… 12 Urgent decompressive colonoscopy can provide a chance for diagnosis and treatment in severe CDI with pseudomembranouscolitis (PMC). 15 , 16 Gastroenterology guidelines 17 recommend the option of oral and per rectum vancomycin plus IV metronidazole treatment for complicated CDI patients with ileus, toxic colon and significant abdominal distension. The vancomycin dosage is 500 mg orally 4 times per day and 500 mg in approximately 100 mL normal saline per rectum every 6 h as a retention enema.…”