LOW ALBUMIN GRADIENT ASCITES COMPLICATING SEVERE PSEUDOMEMBRANOUS COLITIS

Pseudomembranous colitis (PMC) is a frequently severe, sometimes fatal iatrogenic disease that is antibiotic-associated in almost all cases, The most common clinical features of PMC include abdominal pain, wate ry diarrhea, fever, leukocytosis, hypoalbuminemia, and hypovolemia. As cites, not considered a well-known feature of PMC, is fairly common, b ased on a review of the English language literature but has not been c haracterized fully, This case report describes 5 patients with PMC who presented with low serum-ascites albumin gradient (SAAG) and neutrocy tic ascites, without evidence of infectious, malignant, or inflammator y peritoneal disease, which has not been reported previously, In 1 pat ient, massive low SAAG ascites was the presenting manifestation of PMC , a feature also not reported previously, Three of the 5 (60%) patient s had acquired immunodeficiency syndrome. The characteristics of the f luid specimens in these 5 patients and the possible pathogenetic mecha nisms are proposed. The findings suggest that PMC should be included i n the differential diagnosis of low SAAG ascites, especially in patien ts with acquired immunodeficiency syndrome.