Toxic megacolon associated with clostridium difficile infection - A case study

Abstract

© 2017, Serbian Medical Society. All rights reserved. Hyper virulent bacterial strain and irrational antibiotics use are among main causes of incidence increase in Clostridium difficile infection. The most difficult complication of clostridia infection is toxic megacolon with the incidence of 0.4 - 3 % of cases. The study shows a female 56-year-old patient hospitalized at Infectious Disease Clinic in Kragujevac, on the fourth day of the disease, with stomach ache, nausea, vomiting and diarrhea. The patient was previously hospitalized at Pulmonary Clinic for twenty-two days where she had been treated for pneumonia with combined antibiotic therapy. Laboratory analyses showed increased levels of leucocytes (WBC 50.4×109/L), nitrates (urea: 15.4 mmol/l, creatinine: 328 mmol/L) and C-reactive proteins (CRP: 221.2 mg/L), while albumin levels were decreased (16 g/L). Stool was positive on Clostridium difficilyэ. Computerized tomography (CT) was used to visualize diffuse thickening of colon’s wall, especially ascendant, with peritoneum density increase and the presence of free liquid. Despite eradication antibiotic (amp. Vankomycin 125mg/6h per os, amp. Orvagyl 500mg/8h iv), substitution and symptomatic therapy, as well as multidisciplinary approach, the patient passed away on the third day of hospitalization. Recognizing risk factors for clostridia infection onset, monitoring clinical course of the disease, adequate medicament therapy, and early surgical intervention due to complications can lead to lower morbidity and mortality infection rates.