Uncanny Association Between Clostridioides difficile and Microscopic Colitis
Recommended Citation
Singh B, Ethakota J, Bai S, Ranjan N, Quereshi A, Ramanan S, Sridhar N, Koo TH, Kaur G, Maraj D, Zreik H, Santos R, Bern M. Uncanny Association Between Clostridioides difficile and Microscopic Colitis. Am J Gastroenterol 2024; 119(10):S1929.
Document Type
Conference Proceeding
Publication Date
10-1-2024
Publication Title
Am J Gastroenterol
Abstract
Introduction: Chronic diarrhea is often misdiagnosed as irritable bowel syndrome with diarrhea, especially in women with anxiety, depression, or fibromyalgia. This case highlights the need for thorough evaluation of chronic diarrhea. Causes like bile salt diarrhea post-cholecystectomy, small intestinal bacterial overgrowth in diabetics or post-anastomotic surgery, chronic pancreatitis in type 1 diabetics, and giardiasis near water bodies should be considered. Celiac disease and inflammatory bowel disease should be explored especially with family history. After years of empiric treatment, a colonoscopy during an acute exacerbation of chronic diarrhea led to a diagnosis of microscopic colitis (MC), prompting the discontinuation of selective serotonin reuptake inhibitors (SSRIs), which are a known risk factor. Concurrently, Clostridioides difficile diarrhea, initially missed due to a negative antigen test, was correctly identified via polymerase chain reaction. MC and C. difficile have a reciprocal relationship, where one can predispose to the other. Case Description/Methods: A 47-year-old woman with anxiety, migraines, and chronic diarrhea post-cholecystectomy presented with worsening symptoms. She developed diarrhea after 2 courses of Augmentin for sinusitis, with a subsequent computed tomography revealing pancolitis. Initial stool cultures were negative. Despite a course of ciprofloxacin and Flagyl, her symptoms worsened post-treatment. Family history included Crohn's disease. Daily medications included Escitalopram and cholestyramine. She had leukocytosis, and stool studies including C. difficile toxin were negative. Due to high suspicion, a polymerase chain reaction for C. difficile was ordered and returned positive. Treatment with oral vancomycin improved her symptoms significantly. A follow-up colonoscopy with biopsies diagnosed lymphocytic colitis. SSRI discontinuation was advised, and a tapering course of Budesonide was initiated. Discussion: MC, including collagenous colitis and lymphocytic colitis, presents with chronic watery diarrhea. MC is associated with medications like proton pump inhibitors, SSRIs, and nonsteroidal antiinflammatory drugs. Diagnosis requires colonoscopy and biopsies, as the colon appears normal macroscopically. Treatment typically involves a budesonide taper. Persistent diarrhea or recurrent C. difficile infections warrant colonoscopy with random biopsies to check for MC. This case suggests a possible link between C. difficile infection and lymphocytic colitis, supported by recent studies. MC risk factors include older age, female sex, and smoking. Prior gastrointestinal infections, including C. difficile, are more common in MC patients.
Volume
119
Issue
10
First Page
S1929
