Toxic megacolon: rare complication of a common agent

Abstract

In the last decade the incidence and severity of Clostridium difficile
(C. difficile) colitis has markedly increased. This case report is
about a rare presentation of Clostridium difficile infection: toxic
megacolon. It is a life-threatening complication which requires
early recognition and prompt treatment with intravenous metronidazole, oral vancomycin and vancomycin enema. A case of an
88-year-old woman who had abdominal distension, high-grade
fever and profuse watery diarrhea after treatment of a urinary tract
infection with amoxicillin and clavulanic acid is presented. Abdominal and pelvic CT scan revealed an impressive colon dilation,
consistent with toxic megacolon. Stool enzyme immunoassay for
C. difficile was positive. Despite aggressive medical treatment,
she died 8 hours after admission. Since most cases of C. difficile
are both iatrogenic and nosocomial, every effort should be made
to avoid indiscriminate use of antibiotics.