Toxic megacolon from fulminant Clostridium difficile infection induced by topical silver sulphadiazine
- Christopher B Tan1,
- Dhyan Rajan2,
- Mitanshu Shah1,
- Shadab Ahmed3,
- Lester Freedman4,
- Kaleem Rizvon2,
- Paul Mustacchia2
- 1Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA
- 2Department of Gastroenterology, Nassau University Medical Center, East Meadow, New York, USA
- 3Department of Infectious Disease, Nassau University Medical Center, East Meadow, New York, USA
- 4Department of Pathology, Nassau University Medical Center, East Meadow, New York, USA
- Correspondence to Dr Christopher B Tan, ctan{at}numc.edu; bryanmd1{at}gmail.com
Summary
Pseudomembranous colitis and toxic megacolon (TM) are well-known complications of Clostridium difficile infections. Systemic antibiotic is considered as the major risk factor for the development of C difficile colitis. However, topical antibiotics are rarely associated with the infection. As previously thought, the use of topical antibiotic is capable of systemic absorption in damaged and denuded skin; sufficient enough to suppress the normal bowel flora. Here, we present an unusual case of TM from C difficile infection induced by topical silver sulphadiazine in a 60-year-old man with immune-bullous pemphigus vulgaris. The diagnosis is further complicated by the absence of diarrhoea as the initial presentation. Despite adequate medical and surgical intervention, the patient had an unfavourable outcome.
Footnotes
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Competing interests None.
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Patient consent Obtained.
