Ultrasound diagnosis of penicillin-induced segmental hemorrhagic colitis

Abstract

Penicillin-induced segmental haemorrhagic colitis (SHC) is a characteristic and striking but rarely diagnosed clinical entity. Bloody diarrhea and abdominal cramps start a few days after the intake of oral penicillin derivatives. We report the ultrasonographic and clinical findings in nine patients with SHC and compare the results with the findings in ten patients with antibiotic-related pseudomembranous colitis (PMC). Nine consecutive patients with SHC (age: 32 +/- 10 years; five males, four females) with PMC-negative proctoscopic findings, stool cultures and negative clostridium difficile toxin and ten patients with PMC (age: 50 +/- 18 years; six males, four females) with positive proctoscopy and Clostridium difficile toxin were clinically evaluated and examined by high resolution ultrasonography. The sonographic findings of the colonic and small bowel walls as well as the clinical course of the diseases were documented. In all nine patients with SHC the wall of the ascending colon was asymmetrically thickened with loss of layer structure. Neither the small bowel nor the cecum were involved in patients with SHC. In all cases a distinct border between involved and uninvolved colon wall was found. During follow-up all patients recovered soon after stopping antibiotic treatment and symptomatic care. In seven of ten patients with PMC pancolitis and in three of ten with left-sided colitis were found at ultrasonography. In all patients with PMC the bowel wall was symmetrically thickened with the layers remaining distinct. The knowledge of the clinical characteristics and sonographic findings of penicillin-induced segmental haemorrhagic colitis may reduce the need for invasive endoscopic and radiological investigations in diagnosis and follow-up. The age of patients, clinical course and sonographic findings may be helpful in differentiating patients with SHC and PMC.