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Fulminant clostridiosis in ulcerative colitis

Nuster Shiho, Ivan Abadzhiev, Ivo Magardichyan, Oganes Vardanyan, Niya Rasheva

Abstract

Introduction: Ulcerative colitis is an inflammatory bowel disease of the colon. It presents itself with ulcers and pus, damaged mucosa and a continual course. It usually starts from the rectum and affects other parts of the colon. The histological findings include chronic inflammation of the mucosa, poly­morphonuclear neutrophilic infiltration of the crypts of the colon, presence of crypt abscesses and disturbance of mucosal glands structure. Clostridium difficile is a bacterium which causes colitis by producing toxins that further damage the lining of the colon. These conditions have several forms-acute, sub-chronic, chronic and fulminant. The latter leads to toxic megacolon.

Materials and Methods: A 15-year-old girl was hospitalized due to hematemesis and diarrhoea. Her skin was pale, her face and limbs were oedemic. Blood analysis and microbiology tests, radiographies, CT and MRI scans, sonography, esophagogastroduodenoscopy and colonoscopy were all performed. The results showed various laboratory index deviations, anaemic syndrome, hypoproteinaemia, hy­poalbuminemia, mushy stool mixed with mucus, but no blood. However, only a few days later the pa­tient started bleeding, blood clots and colon mucous were also observed. The bleeding would go on for two days and another colonoscopy was performed while blood infusions were ongoing. On both oc­casions histological samples were taken. The final diagnosis was fulminant clostridiosis in ulcerative colitis. An unanimous decision for colostomy was taken and carried out. An ileostoma was then cre­ated and the surgical intervention was terminated.

Results: Her post-operative period was about a month long. There were complications such as epilep­tic seizures, hypovolemic shock, ascites and pleural effusion. Another bleeding did not occur. Thera­py for both ulcerative colitis and clostridium difficile infection was appointed.

Conclusion: Fulminant ulcerative colitis is a serious condition with high mortality rates by itself, let alone being complicated by clostridium difficile. Histological remission is what is mandatory for a bowel transplant to be placed.


Keywords

paediatrics; gastroenterology, IBD; clostridiosis, fulminant




DOI: http://dx.doi.org/10.14748/ssvs.v2i0.4605

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