著明な粘膜浮腫像を呈したvancomycin治療抵抗性偽膜性腸炎の1例

Abstract

A 77-year-old female was referred because of abdominal pain and diarrhea, which occurred two days after antibiotic treatment (cefotiam, 2ｇ/day) . Because endoscopic examination showed multiple white plaques on the sigmoid colon and Clostridium difficile toxin was detected in colostrum, a diagnosis of pseudomembranous colitis was made. Although oral vancomycin (VCM) administration relieved the symptoms, fever and diarrhea recurred 11 days after the administration of VCM was terminated. Colonoscopy again revealed pseudomembranes as well as marked mucosal edema of the colon. Abdominal CT demonstrated double layers of the large bowels, being compatible with marked mucosal edema. Metronidazole (MTZ) was co-administered with VCM for 15 days and VCM was tapered in 22 days. The abdominal symptoms dissappeared and no abnomality was shown on endoscopic examination. Any relapse of pseudomembranous colitis was not observed after cessation of the treatment. Remarkable mucosal edema of the colon was rarely presented with pseudomembranous colitis and was supposed to be a finding related with VCM-resistancy of pseudomembranous colitis.