SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Pseudomembranous Colitis Secondary to Prolonged Antibiotic Use in an Immunocompromised Patient

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This case report describes a 63-year-old woman with recurrent stage IV breast cancer who developed pseudomembranous colitis (PMC) after prolonged broad-spectrum antibiotic exposure while hospitalized for breast implant rupture and wound complications. She initially received vancomycin and piperacillin-tazobactam, then meropenem for 26 days. Although she did not present with the classic symptom of profuse diarrhea, she became lethargic and developed marked abdominal distention, tenderness, and tympany after several days of constipation.<br /><br />CT imaging showed severe colonic dilation to 9.05 cm, raising concern for toxic megacolon. Stool testing was positive for C. difficile PCR and toxin immunoassay, confirming C. difficile-associated PMC. Meropenem was stopped, and she underwent flexible sigmoidoscopy with decompression and rectal tube placement. She was treated with vancomycin enemas and IV metronidazole, then transitioned to oral fidaxomicin (Dificid) once her encephalopathy improved and she could swallow. She ultimately improved without needing colectomy and was discharged in stable condition.<br /><br />The report emphasizes that PMC can present atypically, especially in immunocompromised or medically complex patients, and that constipation does not exclude C. difficile colitis. Recognized risk factors in this patient included advanced age, prolonged hospitalization, broad-spectrum antibiotics, chemotherapy/hormonal cancer therapy, and underlying malignancy. The authors stress the importance of early diagnosis and treatment to prevent progression to toxic megacolon, which carries high mortality due to perforation, peritonitis, septic shock, and multiorgan failure.

Asset Subtitle

Sara Hassan

Meta Tag

Author List Islam Elkherpitawy, Sara Hassan

Category Clinical Vignettes

Concept Pseudomembranous Colitis

Concept Toxic Megacolon

Concept Clostridioides difficile Infection

Concept Immunocompromised State

Concept Broad-Spectrum Antibiotic

Distinguished Non-Finalist

Presenter Organization Ocean University Medical Center

Presenting Author Sara Hassan

Track Adult

Keywords

pseudomembranous colitis

C. difficile

toxic megacolon

broad-spectrum antibiotics

meropenem

breast cancer

immunocompromised patient

constipation

abdominal distention

fidaxomicin

Pseudomembranous Colitis

Toxic Megacolon

Clostridioides difficile Infection

Immunocompromised State

Broad-Spectrum Antibiotic