Pseudomembranous colitis associated with chemotherapy with 5-fluorouracil

Abstract

Pseudomembranous colitis is frequently associated with antibiotics and more rarely with chemotherapeutic agents such as 5-fluorouracil. The objective of this study is to show that it is possible to confuse this infection with chemotherapy associated toxicity. We present a 54 year old woman who underwent surgery for colorectal cancer and in the first cycle of chemotherapy with 5-fluorouracil developed pseudomembranous colitis. We detected the toxin B of Clostridium difficile in stools and we began early antibiotic treatment. Thus, in patients with post chemotherapy neutropenia and diarrhoea that develop negatively, we have to rule out this infection.

Bidirectional interaction between intestinal microbiome and cancer: opportunities for therapeutic interventions

“…The combination treatment increased tumor size and decreased survival rate Lactobacillus acidophilus restores antitumor efficacy following antibiotic treatment [ 64 , 65 ] Restoration of gut microbiota and epithelial integrity by FMT [ 66 ] and treatment with D-methionine [ 67 , 68 ] prevent infections and ototoxicity without affecting tumor chemotoxicity Paclitaxel Increases gut permeability, as indicated by 5-fold elevation in circulating LPS-binding protein and systemic inflammation [ 69 ] Reduces abundance of Roseburia, Porphyromonadaceae and Akkermanisa Muciniphila [ 69 , 70 ] Chemotherapy-induced peripheral neuropathic pain (CIPN) [ 70 ] CDI [ 71 , 72 ] FMT increases A. Muciniphila abundance and reduces CIPN [ 70 ] 5-Fluoruracil Reduces Clostridium spp. and increases members of Proteobacteria, mainly Enterobacteriaceae [ 73 ] Damages mucosal barrier Mucositis along the entire gastrointestinal tract [ 74 ] CDI [ 75 , 76 ] Oral butyrate supplementation improves gut barrier by reducing inflammation and mucositis [ 77 ] Antibiotics reduce mucositis and cytokine production but also diminish antitumor efficacy [ 78 ] and promote chemotherapy resistance [ 11 ] Cyclophosphamide Triggers disruption of gut barrier by altering bacterial composition Gram-positive bacteria such as Enterococcus hirae , Lactobacillus johnsonii , and L. murinus translocate from gut into mesenteric lymph nodes and spleen [ 56 ]. This enhances immune responses by the production of interferon gamma (IFN-γ) and activation of Th17 cells CDI [ 75 ] Antibiotics against Gram-positive bacteria reduce Th17 responses, and subsequent development of cyclophosphamide-resistance Re-establishment of E. hirae alone restores antitumor activity [ 79 ].…”

Clostridium Difficile Associated Diarrhea in Children with Hematological Malignancy-Experience from a Pediatric Oncologic Centre, Bangladesh

“…Many factors may explain the increased risk of C. difficile infection in children with cancer, including repeated exposure to broad-spectrum antibiotics, the inherent antimicrobial activity of some chemotherapy regimens, extensive and frequent exposure to healthcare facilities or immunosuppressive effects of chemotherapy, including neutropenia [8][9][10][11].…”

Pseudomembranous colitis within radiotherapy field following concurrent chemoradiation therapy: a case report

“…Although disruption of the normal bowel flora due to antibiotic exposure is most often the cause of inflammation caused by C. difficile and its toxins, studies have shown that surgery following chemotherapy7 or chemotherapeutic agents5 can also cause extensive intestinal inflammatory changes by altering the normal bowel flora, leading to the growth of C. difficile and production of its toxins in the absence of antibiotic therapy.…”