Yu Ji Han, Kim Na Young, Lee Hae Min, Lee Ha Ni, Ahn Hyo Jun, Kim Sang Woo, Choi Kyu Yong
Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Korean J Gastroenterol. 2010 Dec;56(6):387-90. doi: 10.4166/kjg.2010.56.6.387.
Pseudomembranous colitis is mainly caused by antibiotics and Clostridium difficile infection. But conditions such as gastrointestinal surgery, antacid medication, anti-neoplastic agent or immunosuppressive agent which influences the normal flora of colon can induce colitis without the administration of any antibiotics. We experienced a 13 year-old male who was taking low-dose methotrexate for juvenile rheumatoid arthritis complained diarrhea and abdominal pain for 3 weeks. Sigmoidoscopic findings revealed diffuse patch yellowish pseudomembranes on the rectum. Histologic finding was compatible to pseudomembranous colitis. His symptom was improved after stop taking methotrexate and the administration of metronidazole. If a patient treated with immunosuppressive agents or antineoplastic agents complains diarrhea, fever or abdominal pain and has not improved with conservative care, pseudomembranous colitis should be taken into account as a differential diagnosis and prompt treatment is required for better prognosis.
伪膜性结肠炎主要由抗生素和艰难梭菌感染引起。但诸如胃肠手术、抗酸药物、抗肿瘤药物或免疫抑制剂等影响结肠正常菌群的情况，在未使用任何抗生素的情况下也可诱发结肠炎。我们遇到一名13岁男性，因幼年类风湿关节炎服用低剂量甲氨蝶呤，出现腹泻和腹痛3周。乙状结肠镜检查发现直肠有弥漫性片状淡黄色伪膜。组织学检查结果与伪膜性结肠炎相符。停用甲氨蝶呤并给予甲硝唑治疗后，他的症状有所改善。如果接受免疫抑制剂或抗肿瘤药物治疗的患者出现腹泻、发热或腹痛，且保守治疗无效，则应考虑伪膜性结肠炎作为鉴别诊断，为了更好的预后需要及时治疗。
