Pseudomembranous Enteritis Presenting as SAIO Mimicking a Case of Small Bowel Crohn’s

Abstract

Background: Pseudomembranous colitis (PMC) is a manifestation of severe colonic disease that is usually associated with Clostridium difficile infection but associated small bowel involvement is rare and presentation as obligating enteropathy is even rarer. Aims and Methods: 21 years old medical student residing in south India presented with history of recent onset of vomiting of 2-3 weeks, mild abdominal distention and occasional colic for 1 week and mild degree fever for 2 days. She gives h/o recurrent lower abdominal pain and bloody stools of 9 months for which she underwent upper and lower GI scopes and was diagnosed with Biopsy proven IBD-UC - Montreal L2 with mild to moderate severity and was well controlled with 5 ASA. She was asymptomatic until presentation. Investigations s/o Elevated TC with neutrophilic predominance, CRP ,Anaemia, Hypoalbuminemia ,vit D def. She was started on Iv antibiotics and mesacol along with supportive mediations, Septic workup, AxR, was Wnl. Colonoscopy suggestive of Inflammatory Pancolitis with some whitish exudates in R colon? PMC,UC-EIS 9, UGI scopy s/o D2D3 narrowing with superficial ulcerations, Stools C/s, CD toxins/GDH. Based on this her immunosuppressants were titrated and modified along with treatment for PMC were initiated. She improved and was discharged after 10 days. Biopsy suggestive of UC associated Entropathy with f/s/o Pseudo- membraneous enteritis. along with focal enhanced gastritis with a single periglandular granuloma. CTenterography done after 2 weeks were essentially normal. Currently she is nearly asymptomatic on azathioprine, steroids and metronidazole is doing well. Results:PMC Enterocolitis needs to be thought as a differential of patient presenting with proximal bowel disease with IBD-UC. Though rare can present as a close mimicker of CD. Conclusion: PMC is a rare cause of Obstructive enteropathy. PMC needs to thought as a differential in a patient with proximal bowel involvement in a patient with Ulcerative colitis. Keywords: PMC, Entero Colitis, Abdominal Pain