Colon, Clostridium difficile associated pseudomembranous colitis [LMP48749]

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Diagnostic Modality: 
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Disease Category: 
Infectious Diseases
Diagnosis: 
Clostridium difficile associated pseudomembranous colitis
Species: 
Human
Organ System: 
Gastrointestinal Tract
Gender: 
Female
Age: 
60 years
Diagnosis Code: 
ICD-10: A04.7
Slide Contributor Information
Yang, H., Hsieh, E.

Keywords

C. difficile, pseudomembranous colitis, toxic megacolon

Clinical History

Prolonged course in hospital due to cardiac arrest and pneumonia and further complicated by fulminant C. difficile colitis requiring subtotal colectomy.

Clinical Discussion

Clostridium difficile is a nosocomial GI pathogen commonly associated with prior antibiotic exposure. The clinical spectrum of disease is highly variable and ranges from mild diarrhea to fulminant disease with toxic megacolon or perforation.

In this case, the colon was grossly edematous and covered with innumerable green-yellow loosely adherent patches (ie. pseudomembranes). Microscopically, the pseudomembranes are seen characteristically as scattered areas of dilated and necrotic crypts with eruptions of fibrin, mucin, and neutrophils imparting a "volcano eruption" or "mushroom" appearance. More extensive necrosis of the mucosa and muscularis propria may be seen in prolonged cases.

It is important to note that pseudomembranous colitis is a descriptive term. While most cases are related to C.difficile infection, this condition can occur in the setting of other enteric infections. Ischemic colitis may also have a similar appearance with the formation of pseudomembranes.