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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
Toxic megacolon from fulminant Clostridium difficile infection induced by topical silver sulphadiazine
  1. Christopher B Tan1,
  2. Dhyan Rajan2,
  3. Mitanshu Shah1,
  4. Shadab Ahmed3,
  5. Lester Freedman4,
  6. Kaleem Rizvon2,
  7. Paul Mustacchia2
  1. 1Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA
  2. 2Department of Gastroenterology, Nassau University Medical Center, East Meadow, New York, USA
  3. 3Department of Infectious Disease, Nassau University Medical Center, East Meadow, New York, USA
  4. 4Department of Pathology, Nassau University Medical Center, East Meadow, New York, USA
  1. 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.

https://doi.org/10.1136/bcr-2012-006460

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    Footnotes

    • Competing interests None.

    • Patient consent Obtained.