Fady Banno, MD, MSc, Kyle Knight, DO, Brandon Wiggins, DO, MPH, Carlos Diola, BS, Nathan Landesman, DO Ascension Genesys Hospital, Grand Blanc, MI
Introduction: The manifestations of pseudomembranous colitis (PMC) are usually in a hospitalized individual presenting with diarrhea and fever in the context of a clostridioides difficile infection (CDI). However, in this case we describe a Multiple Myeloma patient who presents with acute colonic obstruction as the first sign of PMC which appeared as an apple core lesion on computed tomography (CT scan).
Case Description/Methods: A 63-year old male with past medical history significant for end stage renal disease, chronic hypotension, and multiple myeloma who presented to the emergency department complaining of 1 week of diarrhea and abdominal pain. He was hemodynamically unstable and was transferred to the intensive care unit. Lab work revealed normal leukocyte count, and hypokalemia. Computed tomography (CT) of the abdomen and pelvis displayed the development of a bowel obstruction secondary to stricture visualized at the proximal transverse colon, suspicious for primary colon cancer. Although he had normal lactic acid, there was a concern for ischemic colitis or toxic megacolon, he was taken to surgery and was found to have pseudomembranous colitis and friable membranes of his transverse colon that lead to the formation of apple core lesion on CT scan.
Discussion: PMC should be on the differential in patients with a baseline inflammatory state with CT findings suggesting apple core lesion or obstruction. Friable colon secondary to pseudomembranous colitis or ischemia could cause the intestines to collapse easily which may show an apple core lesion on CT scan.
Figure: Computed tomography of the abdomen and pelvis demonstrating apple core lesion
Disclosures:
Fady Banno indicated no relevant financial relationships.
Kyle Knight indicated no relevant financial relationships.
Brandon Wiggins indicated no relevant financial relationships.
Carlos Diola indicated no relevant financial relationships.
