DOI QR코드

DOI QR Code

Rifampin-induced Pseudomembranous Colitis with Rectosigmoid Sparing

  • Yim, Sun-Young (Department of Internal Medicine, Korea University College of Medicine) ;
  • Koo, Ja-Seol (Department of Internal Medicine, Korea University College of Medicine) ;
  • Kim, Ye-Ji (Department of Internal Medicine, Korea University College of Medicine) ;
  • Park, Sang-Jung (Department of Internal Medicine, Korea University College of Medicine) ;
  • Kim, Jin-Nam (Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine) ;
  • Jung, Sung-Woo (Department of Internal Medicine, Korea University College of Medicine) ;
  • Yim, Hyung-Joon (Department of Internal Medicine, Korea University College of Medicine) ;
  • Lee, Sang-Woo (Department of Internal Medicine, Korea University College of Medicine) ;
  • Choi, Jai-Hyun (Department of Internal Medicine, Korea University College of Medicine) ;
  • Kim, Chang-Duck (Department of Internal Medicine, Korea University College of Medicine)
  • Published : 2011.12.30

Abstract

Pseudomembranous colitis (PMC) is known to be associated with antibiotic treatment, but is not commonly related to antitubercular (anti-TB) agent, rifampin. PMC is frequently localized to rectum and sigmoid colon, which can be diagnosed with sigmoidoscopy. We report a case of rifampin-induced PMC with rectosigmoid sparing in a pulmonary tuberculosis patient. An 81-year-old man using anti-TB agents was admitted with a 30-day history of severe diarrhea and general weakness. On colonoscopy, nonspecific findings such as mucosal edema and erosion were found in sigmoid colon, whereas multiple yellowish plaques were confined to cecal mucosa only. Biopsy specimen of the cecum was compatible with PMC. Metronidazole was started orally, and the anti-TB medications excluding rifampin were readministerred. His symptoms remarkably improved within a few days without recurrence. Awareness of rectosigmoid sparing PMC in patients who develop diarrhea during anti-TB treatment should encourage early total colonoscopy.

Keywords

References

  1. Rubesin SE, Levine MS, Glick SN, Herlinger H, Laufer I. Pseudomembranous colitis with rectosigmoid sparing on barium studies. Radiology 1989;170:811-813. https://doi.org/10.1148/radiology.170.3.2916034
  2. Bartlett JG. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med 2002;346:334-339. https://doi.org/10.1056/NEJMcp011603
  3. Jung SW, Jeon SW, Do BH, et al. Clinical aspects of rifampicin-associated pseudomembranous colitis. J Clin Gastroenterol 2007;41:38-40. https://doi.org/10.1097/MCG.0b013e31802dfaf7
  4. Chen TC, Lu PL, Lin WR, Lin CY, Wu JY, Chen YH. Rifampin-associated pseudomembranous colitis. Am J Med Sci 2009;338:156-158. https://doi.org/10.1097/MAJ.0b013e31819f1eec
  5. Akbar DH, Al-Shehri HZ, Al-Huzali AM, Falatah HI. A case of rifampicin induced pseudomembraneous colitis. Saudi Med J 2003;24:1391-1393.
  6. Moriarty HJ, Scobie BA. Pseudomembranous colitis in a patient on rifampicin and ethambutol. N Z Med J 1980;91:294-295.
  7. Klaui H, Leuenberger P. Pseudomembranous colitis due to rifampicin. Lancet 1981;2:1294.
  8. George RH. Pseudomembranous colitis probably due to rifampicin. Lancet 1980;1:1304.
  9. Park JY, Kim JS, Jeung SJ, Kim MS, Kim SC. A case of pseudomembranous colitis associated with rifampin. Korean J Intern Med 2004;19: 261-265. https://doi.org/10.3904/kjim.2004.19.4.261
  10. Nakajima A, Yajima S, Shirakura T, et al. Rifampicin-associated pseudomembranous colitis. J Gastroenterol 2000;35:299-303. https://doi.org/10.1007/s005350050350
  11. Barbut F, DecrbuD, Burghoffer B, et al. Antimicrobial susceptibilities and serogroups of clinical strains of Clostridium difficile isolated in France in 1991 and 1997. Antimicrob Agents Chemother 1999;43:2607-2611.
  12. Bendle JS, James PA, Bennett PM, Avison MB, Macgowan AP, Al-Shafi KM. Resistance determinants in strains of Clostridium difficile from two geographically distinct populations. Int J Antimicrob Agents 2004; 24:619-621. https://doi.org/10.1016/j.ijantimicag.2004.06.013
  13. LaHatte LJ, Schuman BM. Antibiotic-associated injury to the gut. In: Haubrich WS, Schaffner F, Berk JE, eds. Bockus Gastroenterology. 5th ed. Philadelphia: WB Saunders; 1995. p. 1657-1671.
  14. Fournier G, Orgiazzi J, Lenoir B, Dechavanne M. Pseudomembranous colitis probably due to rifampicin. Lancet 1980;1:101.
  15. Woo ML, Cho JH, Kim JH, et al. Anti-tuberculosis agents induced Pseudomembranous colitis treated with maintaining anti-tuberculosis drugs. Korean J Gastrointest Endosc 2009;38:47-51.
  16. Burbige EJ, Radigan JJ. Antibiotic-associated colitis with normal-appearing rectum. Dis Colon Rectum 1981;24:198-200. https://doi.org/10.1007/BF02962335
  17. Tedesco FJ, Corless JK, Brownstein RE. Rectal sparing in antibiotic-associated pseudomembranous colitis: a prospective study. Gastroenterology 1982;83:1259-1260.
  18. Gonenne J, Pardi DS. Clostridium difficile: an update. Compr Ther 2004; 30:134-140.

Cited by

  1. A case of pseudomembranous colitis associated with antituberculosis therapy in a patient with tuberculous meningitis vol.15, pp.1, 2011, https://doi.org/10.12729/jbr.2014.15.1.044
  2. Incidence and Clinical Outcomes of Clostridium difficile Infection after Treatment with Tuberculosis Medication vol.10, pp.2, 2011, https://doi.org/10.5009/gnl14435
  3. Drug-Induced Colitis vol.19, pp.9, 2021, https://doi.org/10.1016/j.cgh.2020.04.069