Toxic pseudomembranous colitis in a patient with ulcerative colitis

Toxic colitis is a severe disease that may be caused by several inflammator y and/or infectious diseases. Ulcerative colitis is one of the most frequen t causes of toxic colitis in the United States. Toxic megacolon complicatin g Clostridium difficile colitis is a rare occurrence with significant morbi dity and mortality. Case Reports A 52-year-old male presented with rectal b leeding and tenesmus. He had been treated for amebiasis with metronidazole, and had improved. Two weeks later, symptoms recurred, and he was referred to our hospital. A sigmoidoscopy and biopsies demonstrated mucosal ulcerati ve colitis. He underwent treatment with systemic prednisone, mesalamine, an d hydrocortisone enemas with adequate response. He was asymptomatic for 2 m onths, but later presented with a tender abdomen and rectal bleeding. Plain abdominal and thorax films showed colonic distention and free intraperiton eal air. Emergency laparotomy was performed, and an inflamed and distended colon, with free inflammatory liquid in the peritoneum, was found. A total abdominal colectomy with temporary ileostomy and Hartmann's pouch was perfo rmed. The histopathology analysis demonstrated a Clostridium difficile pseu domembranous colitis. Conclusion: The presence of toxic megacolon due to Cl ostridium difficile in patients with ulcerative colitis is a rare complicat ion that may be suspected in patients with initial relapse who are on antib iotics.