Ultrasonography in the diagnosis of penicillin-induced segmental haemorrhagic colitis

Introduction: Penicillin-induced segmental haemorrhagic colitis (SHC) is a characteristic and striking but rarely diagnosed clinical entity. Bloody di arrhoe and abdominal cramps start a few days after the intake of oral penic illin derivatives. We report the ultrasonographic and clinical findings in nine patients with SHC and compare the results with the findings in ten pat ients with antibiotic-related pseudomembranous colitis (PMC). Methods: Nine consecutive patients with SHC (age: 32 +/- 70 years; five mal es, four females) with PMC-negative proctoscopic findings, stool cultures a nd negative clostridium difficile toxin and ten patients with PMC (age: 50 +/- 18 years; six males, four-females) with positive proctoscopy and Clostr idium difficile toxin were clinically evaluated and examined by high resolu tion ultrasonography. The sonographic findings of the colonic and small bow el walls as well as the clinical course of the diseases were documented. Results: In all nine patients with SHC the wall of the ascending colon was asymmetrically thickened with loss of layer structure. Neither the small bo wel nor the cecum were involved in patients with SHC. In all cases a distin ct border between involved and uninvolved colon wall was found. During foll ow-up all patients recovered soon after stopping antibiotic treatment and s ymptomatic care. In seven of ten patients with PMC pancolitis and in three of ten with left-sided colitis were found at ultrasonography. In all patien ts with PMC the bowel wall was symmetrically thickened with the layers rema ining distinct. Discussion: The knowledge of the clinical characteristics and sonographic f indings of penicillin-induced segmental haemorrhagic colitis may reduce the need for invasive endoscopic and radiological investigations in diagnosis and follow-up. The age of patients, clinical course and sonographic finding s may be helpful in differentiating patients with SHC and PMC.