P0212 - Pseudomembranous Colitis in a Young Female With Preoperative Adenocarcinoma of Colon

Praneet Srisailam, MD, Dong Joo Seo, MD, Navya Kirla, MD
Roger Williams Medical Center, Providence, RI

Introduction: Pseudomembranous colitis (PMC) is an inflammatory condition of the colon characterized by raised yellow-white plaques that coalesce to form pseudo membranes on the mucosa and the most common cause being clostridium difficile. The incidence of community acquired Clostridium difficile infection (CDI) is increasing in all populations in the past decade.Weakened immune system could be a cause of PMC. Patients with preoperative colorectal cancer have reported high incidence rates of C. difficile.We present a case of PMC found during colonoscopy in a young female who was recently diagnosed with metastatic colon cancer.

Case Description/Methods: 28-year-old female with history of constipation, invasive adenocarcinoma of sigmoid colon diagnosed within the past month, awaiting to begin palliative chemotherapy presented for evaluation of 2-day history of lower quadrants abdominal pain. She denied any overt diarrhea but reports few episodes of loose stools on day of presentation, with no melena/ hematochezia. She denies history of Inflammatory bowel disease, unintentional weight loss, family history of colon malignancies, recent travel, sick contacts, recent antibiotic use. The patient was afebrile but found to have an elevated white cell count with normal lactate levels, CT Abdomen findings concerning for diffuse colitis. Patient had a colonoscopy two weeks prior for initial evaluation of colonic mass, with no evidence of any concomitant colitis. Additional work up including stool c difficile DNA amp, cultures/studies, fecal ova and parasites, shigella toxin, C. difficile toxin turned out to be negative. Patie nt was started on empiric broad spectrum antibiotics with no improvement in clinical picture. Subsequently, patient underwent intraluminal examination with colonoscope which showed diffuse pseudo membranes in the entire colon associated with congested mucosa in the ascending colon. Biopsies sent from colonoscopy showed active colitis with neutrophilic exudates (pseudo membranes) consistent with CDI. Then she was started on oral vancomycin therapy with good effect.

Discussion: Our patient likely developed PMC due to weakened immune system. In this case, had we not performed a colonoscopy we would have not made an early diagnosis. Clinicians should have high suspicion of CDI in pre operative colorectal cancer patients presenting with diffuse Colitis. Early diagnosis and treatment are essential for preventing progression to more serious conditions like toxic megacolon, intestinal perforation.



Disclosures:


Praneet Srisailam, MD, Dong Joo Seo, MD, Navya Kirla, MD. P0212 - Pseudomembranous Colitis in a Young Female With Preoperative Adenocarcinoma of Colon, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.