Nilofar Fathima, Babu Nithesh, Kumar Mahendra, Palanisamy Saranya, T Gnanadeepan
General Medicine, Saveetha Medical College and Hospital, Chennai, IND.
Cureus. 2024 Jul 23;16(7):e65176. doi: 10.7759/cureus.65176. eCollection 2024 Jul.
Pseudomembranous colitis (PC) is an inflammation of the colon primarily caused by the bacterium Clostridium difficile (C. difficile), often following antibiotic use. This case report describes the intricate clinical course of a 48-year-old male farmer with a history of chronic alcoholism, tobacco use, and seizure disorder, who presented with acute onset of left-sided weakness. CT brain revealed an intra-axial hemorrhage in the right gangliocapsular region with significant edema and midline shift. The patient's condition necessitated mechanical ventilation due to a low Glasgow Coma Scale (GCS) score. Complications ensued with the onset of ventilator-associated pneumonia (VAP) on day six, attributed to multi-drug resistant Acinetobacter baumannii, which was managed with meropenem and polymyxin. Following successful weaning from the ventilator, he experienced severe watery diarrhea, high-grade fever, and diffuse abdominal pain on day 13. Subsequent stool tests confirmed PC caused by C. difficile, characterized by diffuse colonic wall-thickening with a water target sign on contrast-enhanced CT (CECT) abdomen. Initial treatment with oral vancomycin and metronidazole was followed by symptomatic treatment. Two weeks later, the patient had a relapse of PC, presenting with multiple episodes of loose stools, which was managed with oral metronidazole alone. Colonoscopy and biopsy confirmed the relapse, showing inflamed colonic mucosa with pseudomembranes. This case highlights the importance of strict infection control, prudent antibiotic use, and close monitoring for these patients. It also suggests the potential role of fecal microbiota transplantation (FMT) for recurrent cases. The patient's recovery demonstrates the effectiveness of meticulous medical management and adherence to infection control protocols in achieving optimal outcomes.
伪膜性结肠炎（PC）是一种主要由艰难梭菌引起的结肠炎症，通常发生在使用抗生素之后。本病例报告描述了一名48岁男性农民复杂的临床病程，该患者有慢性酒精中毒、吸烟史和癫痫病史，表现为急性左侧肢体无力。脑部CT显示右侧神经节囊区轴内出血，伴有明显水肿和中线移位。由于格拉斯哥昏迷量表（GCS）评分较低，患者的病情需要机械通气。在第六天，患者出现了呼吸机相关性肺炎（VAP）并发症，病原体为多重耐药鲍曼不动杆菌，使用美罗培南和多粘菌素进行治疗。成功撤机后，患者在第13天出现严重水样腹泻、高热和弥漫性腹痛。随后的粪便检测证实为艰难梭菌引起的PC，腹部增强CT（CECT）显示结肠壁弥漫性增厚，呈靶征。最初使用口服万古霉素和甲硝唑治疗，随后进行对症治疗。两周后，患者PC复发，出现多次稀便，仅用口服甲硝唑治疗。结肠镜检查和活检证实了复发，显示结肠黏膜发炎并伴有伪膜。本病例强调了严格感染控制、谨慎使用抗生素以及对这些患者密切监测的重要性。它还提示了粪便微生物群移植（FMT）对复发病例的潜在作用。患者的康复证明了精心的医疗管理和遵守感染控制方案在实现最佳治疗效果方面的有效性。
