Development of pseudomembranous colitis four months after initiation of rifampicin.

Abstract

Pseudomembranous colitis (PMC) may develop with long-term antibiotic administration, but is rarely reported to be caused by antitubercular agents. We present a case of PMC that occurred 120 days after starting rifampicin. A 74-year-old man was diagnosed with pulmonary tuberculosis and started on a standard HERZ regimen (isoniazid, ethambutol, rifampicin, pyrazinamide). After 4 months of HERZ, he presented with frequent bloody, mucoid, jelly-like diarrhea and lower abdominal pain. Sigmoidoscopy revealed multiple whitish plaques with edematous mucosa that were compatible with PMC. Biopsies from these lesions showed ulcer-related necrotic and granulation tissue. We stopped antitubercular treatment and started the patient on oral metronidazole. His symptoms completely resolved within 2 weeks. Antitubercular treatment was restarted by replacing rifampicin with levofloxacin. The patient did not present with diarrhea or bloody stool throughout the rest of treatment.

• Authors: Jeong Moon Choi, Hyung Hun Kim, Seun Ja Park, Moo In Park, Won Moon
• Journal: Case reports in gastroenterology (Case Rep Gastroenterol) Vol. 5 Issue 1 Pg. 45-51 (Jan 14 2011) ISSN: 1662-0631 [Electronic] Switzerland
• PMID: 21326858 (Publication Type: Case Reports)