Clostridium Difficile Infection—An Unusual Cause of Refractory Pouchitis: Report of a Case

Mann, Simran; Pitt, J; Springall, R G; Thillainayagam, Andrew V.

doi:10.1007/s10350-004-6533-1

Cited by 112 publications

(40 citation statements)

References 17 publications

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“…Mann et al [7] reported the first case of Clostridium difficile-associated pouchitis. A 35-year-old female patient with chronic refractory pouchitis was found to have Clostridium difficile infection while on metronidazole and prednisone.…”

Section: Discussionmentioning

confidence: 98%

“…Clostridium ina propria is normocellular, and the villous architecture is intact. The crypts are also regularly distributed difficile is a common nosocomial pathogen responsible for most cases of pseudomembranous colitis and up to 20% of cases of antibiotic-associated diarrhea [7]. Clostridium difficile is prone to colonize the colonic mucosa, but occasionally colonize the mucosa of the small bowel [14,15].…”

Section: Discussionmentioning

confidence: 99%

“…It is important to investigate why these patients do not respond to conventional antibiotic therapy. Possible causes include non-steroidal anti-inflammatory drugs (NSAID) use [5,6], concurrent Clostridium difficile [7] or cytomegalovirus (CMV) infection [8,9], celiac disease, cuffitis, and Crohn's disease (CD) [6].…”

Section: Introductionmentioning

confidence: 99%

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Clostridium Difficile-Associated Pouchitis

et al. 2006

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Pouchitis is the most common long-term sequela of ileal pouch-anal anastomosis (IPAA) following total proctocolectomy. No single pathogen is identified as being solely responsible for the pathogenesis of the disease. Here we describe a case of Clostridium difficile-associated pouchitis that was successfully treated with ciprofloxacin and tinidazole. Diagnosis and management of a patient with medically refractory pouchitis associated with Clostridium difficile infection is described. A 63-year-old male with underlying ulcerative colitis and IPAA presented with increased stool frequency and seepage for 2 months, which partially responded to oral metronidazole. While on the antibiotic therapy, pouch endoscopy was performed and showed severe pouchitis. Assays for Clostridium difficile toxins in stool specimens were positive. He was treated with a 4-week course of ciprofloxacin 500 mg BID and tinidazole 500 mg TID. His symptoms resolved within several days from the initiation of therapy. A repeat pouch endoscopy at week 5 showed a complete resolution of mucosal inflammation of the pouch, while tests for Clostridium difficile toxins became negative. Clostridium difficile-associated pouchitis is rare. However, Clostridium difficile infection should be excluded in patients with chronic refractory pouchitis.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Clostridium Difficile-Associated Pouchitis

et al. 2006

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“…7 An unusual feature in the case that we describe is the nodularity seen at flexible sigmoidoscopy. This is not a typical finding in C. difficile-associated colitis; diffuse inflammation and pseudomembranes are more commonly seen.…”

Section: Discussionmentioning

confidence: 86%

“Diversion” Colitis Caused by Clostridium difficile Infection: Report of a Case

Tsironi

Irving

Feakins

et al. 2006

Diseases of the Colon &Amp; Rectum

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Recurrent ulcerative colitis and/or diversion colitis occur commonly in the rectal remnant after colectomy for ulcerative colitis. We report a case in which such a patient's symptoms of rectal discharge were initially thought to be the result of one or both of these diagnoses, on both clinical and histologic grounds. However, examination of the discharge revealed Clostridium difficile infection. Treatment with metronidazole suppositories improved his symptoms and avoided further inappropriate intervention.

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“…It is important to investigate why patients do not respond to antibiotic therapy. Possible reasons include NSAID use, 33 concurrent C. difficile 34 or CMV infection, 35,36 celiac disease, cuffitis, and CD. After the exclusion of these factors, there are several treatment options.…”

Section: Discussionmentioning

confidence: 99%