Abstract
OBJECTIVE: The classic manifestation of Clostridium difficile (CD) infection is pseudomembranous colitis (PMC) with diarrhea. Rarely, it can be present as toxic megacolon without diarrhea. We present a case of CD PMC without diarrhea to heighten awareness of its atypical presentation. DESCRIPTION: An 80-year-old male with multiple comorbidites and history of recent antibiotic treatment for chronic obstructive pulmonary disease and exacerbation presented with fever, shortness of breath, and abdominal pain. The patient had no complaints of diarrhea. An abdominal x-ray showed markedly dilated transverse colon with a diameter of 14.5 cm. A computed tomography scan of the abdomen showed thickened loops of transverse colon. A diagnosis of toxic megacolon was made. The patient was treated with intravenous metronidazole. The patient then underwent colonoscopic decompression that revealed PMC and vancomycin was added to the drug regimen. A stool study was positive for CD cytotoxins. There was complete resolution of the patient's colonic dilation following the colonoscopic decompression. CONCLUSION: The unusual combination of toxic megacolon without antecedent diarrhea should be recognized as a possible manifestation of CD PMC. Atypical presentations of this common disease necessitate an aggressive diagnostic approach for an appropriate therapeutic plan.
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