Alonge Marco, Benini Federica, Cannatelli Rosanna, Pozzi Alessandro, Missale Guido, Villanacci Vincenzo, Ricci Chiara
Gastroenterology Unit, Department of Clinical and Experimental Sciences, University of Brescia and Spedali Civili, Brescia, Italy.
Gastroenterology Unit, Department of Clinical and Experimental Sciences, University of Milan and Spedali Civili, Brescia, Italy.
Case Rep Gastroenterol. 2020 Apr 29;14(1):242-247. doi: 10.1159/000507014. eCollection 2020 Jan-Apr.
Ischaemic colitis (IC) is the most frequent form of ischaemia of the digestive tract. Due to the worldwide increasing use of medications, there is a growing interest in drug-induced IC. This study reports a rare case of IC directly due to amoxicillin-clavulanate intake. The objective of the study was to describe the evolution of this novel manifestation. An 18-year-old man, non-smoker, with an insignificant medical history, presented with diarrhoea and cramping abdominal pain that started the day following the end of a 10-day amoxicillin-clavulanate course for recent upper respiratory tract infection. Stool cultures including toxin testing were negative. Colonoscopy documented an erosive-ulcerative colitis of the sigmoid and the descending colon. Histological examination of the colon biopsies revealed an IC with focal pseudomembranous areas in the descending-sigmoid colon. Thrombophilia screening tests were negative. The patient was discharged from the hospital without symptoms, and another colonoscopy was performed 3 weeks after the previous one, which documented normal endoscopic and histological findings. Amoxicillin-clavulanate IC is a very rare condition and should be suspected once infectious diseases, vascular/haemodynamic causes and a prothrombotic/hypercoagulable state have been excluded. Immediate discontinuation of the antibiotic leads to rapid disease remission.
缺血性结肠炎（IC）是消化道缺血最常见的形式。由于全球范围内药物使用的增加，药物性IC越来越受到关注。本研究报告了一例直接由服用阿莫西林克拉维酸导致的罕见IC病例。该研究的目的是描述这种新表现的演变过程。一名18岁男性，不吸烟，既往病史无足轻重，因近期上呼吸道感染接受了为期10天的阿莫西林克拉维酸治疗，治疗结束后次日出现腹泻和腹部绞痛。包括毒素检测在内的粪便培养均为阴性。结肠镜检查显示乙状结肠和降结肠有糜烂性溃疡性结肠炎。结肠活检的组织学检查显示降乙状结肠有局灶性假膜区域的IC。血栓形成倾向筛查试验为阴性。患者无症状出院，在前一次结肠镜检查3周后又进行了一次结肠镜检查，结果显示内镜和组织学检查结果正常。阿莫西林克拉维酸所致IC是一种非常罕见的疾病，一旦排除传染病、血管/血流动力学原因和血栓前状态/高凝状态，就应怀疑此病。立即停用抗生素可使疾病迅速缓解。
