Pseudomembranous colitis: Not always Clostridium difficile

Abstract

Although Clostridium difficile infection is the cause of most cases of pseudomembranous colitis, clinicians should consider less common causes, especially if pseudomembranes are seen on endoscopy but testing remains negative for C difficile or if presumed C difficile infection does not respond to treatment. Histologic review of colonic mucosal biopsy specimens can provide clues to the underlying cause.

Clinical Profile of Clostridium Difficile Associated Diarrhea: A study from Tertiary Care Centre of South India

“…It is a nonspecific pattern of injury which results from decreased oxygenation, endothelial damage, and impaired blood flow. 33 Antibiotic usage is a common cause of diarrhea and is implicated in CDI. Among antibiotics exposure to clindamycin, cephalosporins and fluoroquinolone is maximally associated with CDI.…”

How to: Surveillance of Clostridium difficile infections

“…cytomegalovirus, Entamoeba histolytica, Shigella species, Shiga-toxin producing Escherichia coli) and medication (e.g. cisplatin, cyclosporine A) can cause similar pathology [19].…”

A Comparison of Current Guidelines of Five International Societies on Clostridium difficile Infection Management

“…Although CT scan is a useful tool to diagnose toxic megacolon [ 68 ], other specific radiological findings do not seem to correlate indubitably well with CDI severity [ 69 , 70 ]. Similarly, endoscopic findings with or without colon biopsy may help clarifying diarrhea etiology in cases of a high clinical suspicion and a negative C. difficile stool test [ 71 ], but the presence of pseudomembranous colitis seems to be a less CDI-specific finding than it is generally believed to be [ 72 ], and its relationship with severe outcome has not been demonstrated either [ 73 ].…”