Colonic Mrsa Complicating Ulcerative Colitis

Abstract

Ulcerative colitis is well known to be exacerbated by infections most common being bacterial and viral especially CMV, clostridium difficile and fungal infections. First recognized almost 70 years ago, enterocolitis due to Staphylococcus aureus has been described as both a complication of antibiotic therapy and as occurring in individuals with predisposing conditions but no previous antibiotic treatment. We describe here a unique case of flare up of ulcerative colitis in a young amphetamine user. This was subsequently found to be due to MRSA (methicllin resistant staphylococcus aureus). He was treated successfully. CASE REPORT A 24 year old man presented with 3 weeks history of profuse watery diarrhoea, fever and lower abdominal pain. One week before admission the stool frequency increased to 20 times/day accompanied by bleeding per rectum and vomiting. He abused amphetamine for the past 6 years. He had not travelled abroad recently and denied unprotected sexual contact. HIV and hepatitis C status was unknown and he was on no medications. Physical exam elicited temperature of 39 C, tenderness in left iliac fossa and signs of dehydration. Haemoglobin was 10.1 g/dl (13.5-17.5 g/dl), white blood cells of 28 ×10/L (4-11×10 /L) with neutrophilia 25.7× 10 /L (2.0-7.5 × 10 /L), CRP of 289 mg/L (0-10 mg/L), albumin was 21 g/L (35 – 50 g/L). Stool cultures were negative (no clostridium difficile). Abdominal film showed 6 cm dilated transverse and descending colon. Flexible sigmoidoscopy revealed gross mucosal edema, diffuse erythema and multiple punched out ulcers in rectum and sigmoid colon (Fig A). Figure 1 Fig A shows edematous sigmoid with multiple punched out ulcers. Biopsy excluded ischemic, pseudo-membranous and CMV colitis. CT scan showed inflamed colonic wall (Fig B) Colonic Mrsa Complicating Ulcerative Colitis