A case of ulcerative colitis co-existing with pseudo-membranous enterocolitis.

igure 1 Proctosigmoidoscopy showing characteristic multile elevated, adherent yellowish-white plaques of 2–10 mm in diameter on colonic mucosa forming pseudo-membranes. The overall incidence of Clostridium difficile infection is increasing over the decades and super-infection with C. difficile is also known to exacerbate the underlying inflammatory bowel disease (IBD).1,2 IBD patients with C. difficile infection have longer hospital stay, consume more healthcare resources and also have higher mortality rates than the patients with C. difficile infection alone.3,4 Here, we discuss an IBD patient represented with C. difficile infection who took the exact diagnosis via colonoscopic procedure even after a negative stool examination for C. difficile. A 60 years old woman admitted to our clinic with watery diarrhea, lower abdominal pain, fatigue, malaise, nausea and vomiting for a week. She had a previous medical history of ulcerative colitis for 13 years and was relatively stable with sulfasalazine enema treatment. Of note, the patient did not have antimicrobial exposure within the 3 months prior to admission. Physical examination revealed left-sided abdominal tenderness and signs of mild dehydration as loss of appetite, dry mouth, dry skin and tachycardia. Laboratory results showed mild leukocytosis of 11.8×103μ/L, normal hemoglobin and platelet levels, normal liver enzymes and renal function tests. Serum sodium level was 137 mmol/L (normal: 136–145), and potassium level was 3.2 mmol/l (normal: 3.5–5.1). Acute phase reactants were slightly elevated, C-reactive protein level was 13 mg/L (normal: 0–5) and sedimentation rate was 61 mm/h. Plain films of the abdomen were unremarkable. After hydration and correcting the potassium levels, a proctosigmoidoscopy was performed showing characteristic multiple elevated, adherent yellowish-white plaques of 2–10 mm in diameter on colonic mucosa forming pseudo-membranes consistent with a diagnosis of pseudo-membranous enterocolitis (PMC). The other parts of the colonic mucosa were affected from ulcerative colitis but it was not an active phase of the disease (Fig. 1), and biopsies were obtained. According to the endoscopic view, oral ornidazole treatment was added to the patient's therapy. Stool sample was sent for culture including assay for C. difficile toxin. Toxin assay failed to show any