Samstag, 5. Februar 2011

Pseudomembranöse Kolitis

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A 40-year-old woman presented to the hospital with crampy abdominal pain, nausea, vomiting, watery diarrhea, and leukocytosis (12,900 white cells per microliter). She was admitted with a presumptive diagnosis of infectious colitis and was treated with a 14-day course of ciprofloxacin, with a moderate response. Nine days after discharge, the patient returned to the emergency department with abdominal pain, vomiting, diarrhea, and hypotension. A contrast-enhanced computed tomographic scan of the abdomen showed marked bowel-wall thickening (Panel A, arrows) throughout the sigmoid colon and descending colon. Colonoscopy (Panel B) revealed multiple discrete, yellowish, polypoid lesions and a friable, hyperemic mucosa. Histopathological examination of the biopsy specimens revealed a neutrophilic infiltrate in the lamina propria and mucopurulent exudates erupting through the denuded surface epithelium, findings that confirmed a diagnosis of pseudomembranous colitis (Panel C, hematoxylin and eosin). Results of a test forClostridium difficile toxin, performed 6 days after the second admission, were negative. The patient began treatment with antimicrobial agents and was discharged 117 days later, after complete resolution of the colitis.

Naiming Chen, M.D., and Shin-Lin Shih, M.D.
N Engl J Med 2011; 364:e8

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