Pseudomembranous enterocolitis cured with three intestinal microbiota transplantations

Abstract

SummaryWe present a unique case of a 82 years old women, with this newly described condition called "pseudomembranous enterocolitis cured with three transplants of intestinal microbi0ta (imt)." We evaluated the case of gaw, who had a perforates sigmoid diverticulum 10m days ago and had surgery with sigmoid resection, colostomy and hartmann's pouch. Her progress was good. However, she was given metronidazole and vancomycin, antibiotics that caused severe diarrhea and toxic state, a week postoperatively. Histopathological study of surgical specimen showed colonic mucosa extensively ulcerated and granulation tissue, fibrin and abundant neutrophils. Submucosal edema and acute periserositis. The muscular and mucosal layer had not alterations. A diagnosis of pseudomembranous enterocolitis (pm) was made. The patient had a toxic state, semi-conscious, diaphoretic and extensive erythema in the right forearm, with minor erythema at the left forearm and face, as well as perineal erythema, third degree edema in lower limbs, dehydrated and chest x-ray showed interstitial pneumonitis. She had a typical case of pm, and proceeded to perform an intestinal microbiota transplantation (imt) from healthy donors at clinical and laboratory studies. After that imt we performed colonoscopy, which showed at the course of transverse and right colon multiple plaques of whitish, cotton-like appearance, which protuded on the mucosal surface. This appearance were also seen at the left colon. We applied 400 ml. Of imt in the right colon and 100 ml at the hartmann's pouch of rectum. At the colonoscopy we placed a foley's catheter with an inflated balloon 20 ml. Also, solid petroleum jelly was left to prevent imt elimination. We removed all antibiotic treatment and replaced with probiotics, through the nasogastric tube.Three day later the patient had a better general condition, was conscious, with erythema limited to forearms, face and perineum, the lowers limb had no edema and she was better hydrated.The second imt was performed with another 400 ml. Of microbiota in right colon and 100 ml. At the hartmann's pouch. To prevent imt a 20 ml. Inflated balloon colostomy (foley's catheter) sealed with solid petroleum jelly.Three days later, a new imt was required under the same conditions as the former two imt. On this occasion the patient was fully aware, speaking and responded correctly to our questions. She had no erythema in her body, no edema at her legs and her chest x-ray had no pneumonitis, and showed only a small leak at the base of right lung.Further treatment without antibiotics, was with symbiotic by mouth and was under another treating team.We reviewed the literature, and we hope to encourage colleagues to use this procedure, which had similar results in the world. Presentation of the caseGaw, female, 82 years old with a history of sigmoid diverticulum perforation, peritonitis treated with sigmoid resection, colostomy and hartmann's pouch were given the following antibiotics: metronidazole, vancomycin which caused pseudomembranous enteroc...

Comparative Analysis of the Microbiome across the Gut–Skin Axis in Atopic Dermatitis

“…Previous studies show that various skin conditions appear to be potentially affected by the gut microbiome. In addition to hair loss and psoriasis, changes in acne and eczema in FMT recipients were observed [ 113 , 114 , 115 , 116 , 117 ]. There is also a recent study close to what we want to know, a cohort study involving a chart review of all patients who received FMT from January 2013 to December 2019 in a single academic medical center.…”