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Recent reports have implicated numerous drugs as causal agents of pseudomembranous colitis, a severe gastrointestinal disease. t-J This inflammatory, necrotizing howe! alteration usually involves the mucosa, although submucosal changes have also been reported. 2 •· 1 Before the advent of antibiotics, the term pseudomembranous colitis was used to cover a myriad of acute, frequently fi1tal complications resulting from surgery, debilitating comlitions (leukemia, lymphoma, etc.), intestinal ischemia, and staphylococcal infection. 2 • 5 • 6 Over the last few years this condition has been associated with a number of antibiotics including ampicillin, tetracycline, chloramphenicol, lincomycin, and more recently, clindamycin. 1 • 3 ··•.i Antibiotic-related pseudomembranous colitis has recentlv been attributed to one ~r more toxins produced hy Clostriclium difficile. 2 ·" Clinical symptoms include fever, diardtea with electrolyte imbalance, dehydration, and severe pain mimicking acute abdomen, which may prove fatal. 3 Radiologic findings in pseudomembranous enterocolitis are nonspecific 2 ·Jand indistinguishable from other types of ulcerative inflam· mato'I bowellesions 6 except in severe or advanced cases. !.1 Diagnosis is usually established hv colonoscopy and/or proctosigmoidoscopy. :!,J,i •We report a case of pseudomembranous colitis in which ultrasonography, although not diagnostic, revealed several interesting features of this inflammatory bowel disease. REPORT OF A CASEA 63~rear-old man presented with l1igh fever (up to 40"C), chills, and severe diarrhea, Se\'eral days prior to admission he l1ad suffered a rhinopharyngotmche;~l innammation with fever, hoarseness, and dysphagia. He had been treated at home with 500 mg lincomycin hydrochloride monohydrate orally three times a day. At the end of the third day of antibiotic treatment the patient developed abdominal cramps and non-blood~· diarrhea. At the time of admission the diarrhea had increased to twentv bowel movements per day with the most severe pai1; in the cecum. Address correspondence and repr'nt requests to Dr. Bolondi: I Clinica Medica, Universita di Botogna, Polic linico S. Orsola, Via Massarenti 9, 40138 Bologna, ltalia.tests revealed high serum creatinine levels, increasingly high blood nitrogen, low serum potassium values, mainh• neutrophil leukocytosis (21,000), and no anemia.P\;~in film abdominal radiogmphy showed gas in the loops of the small intestine and distention of the cecum and ascending ami transverse <:ohm ( fig. l).An ultrasound scan was performecusing. Smwgraphi~ (e;~tures included marked distension of all bowel loops, which were full of gas, especially at the level of the cecum and as-<.'ending colon. The transverse and descending <:olon had thickened (10 mm) edematous walls with thickened folds. The colic lumen was hardlv visihle due to marked thickening of the wall ( fig...

The density of the three principal immunoglobulin containing cells (IgA, IgM, IgG) in the human jejunal mucosa was determined in eight adult celiac patients and in eight subjects without any gastrointestinal abnormalities, using immunofluorescent techniques. A statistical comparison of the results showed a particularly significant increase of the IgM cells and a less significant increase of the IgG cells in celiac disease. A decrease of the IgA cells was also found in celiac disease but with no statistical significance. These results are discussed in relation to other phenomena observed in the intestinal wall of celiac patients and indicate the importance of the immunoglobulins in this disease. One particular celiac patient with a high IgG cell count who later developed lymphosarcoma of the intestine is discussed in detail.

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