Pe

VS: fever; tachycardia; tachypnea. PE: moderate dehydration; mild abdominal tenderness with no signs of peritoneal irritation; surgical wound normal.

Labs

CBC: leukocytosis. Stool culture reveals gram-positive rods, Clostridium difficile; presence of toxin in stool.

Imaging

Sigmoidoscopy: mucosal hyperemia, ulcers, and pseudomem-branes.

Gross Pathology

Mucosa hyperemic and swollen; epithelial ulcerations covered by yellowish plaques (pseudomembranes) and fibrinous exudate.

Micro Pathology

Fibrinous exudate with pseudomembrane formation; ulceration of superficial epithelium; neutrophilic infiltrate with necrotic debris.

Treatment

Cessation of offending antibiotic; give metronidazole or oral vancomycin.

Discussion

Pseudomembranous colitis is defined as acute inflammation of die colon in patients taking antibiotics, specifically clindamycin or ampicillin, due to overgrowth of C. difficile; it is characterized by formation of pseudomembranes. Clindamycin acts by blocking protein synthesis at the 50S ribosomal unit. Its main clinical indication is for life-threatening infections with anaerobes.

Atlas Link

racggT] PG-PH-031

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