2016 Volume 58 Issue 10 Pages 2182-2190
In the present report, we describe a rare case of Staphylococcus aureus colitis, wherein hepatic portal venous gas (HPVG) and pneumatosis cystoides intestinalis (PCI) were observed at onset.
A 40-year-old man presenting with hematochezia, abdominal pain and fever was admitted to our hospital. He had been diagnosed with ulcerative colitis (UC) when he was 31 years old. The activity of UC had been maintained in remission since he was prescribed mesalazine. On the current admission, abdominal CT indicated the presence of HPVG and PCI, along with contrast medium-enhanced mucosa and edema of the wall of the rectum and sigmoid colon. On colonoscopic examination, multiple longitudinal ulcers were observed at the rectum and sigmoid colon. Biopsy specimen revealed inflammation involving the infiltration of neutrophils. It was speculated that these longitudinal ulcers caused HPVG and PCI. Administration of antibiotics was started. The differential diagnoses of the current status were exacerbation of UC or the onset of another disease such as infectious colitis. Making the correct diagnosis was initially difficult. However, Staphylococcus aureus was cultured in the stool culture. Based on the stool culture, clinical course and biopsy result of colonoscopy, the patient was diagnosed with Staphylococcus aureus colitis. Antibiotic administration led to improvement of the symptoms, and the patient was discharged on day 7. The multiple longitudinal ulcers at the rectum and sigmoid colon were healed completely and only scars were observed on colonoscopy performed three months later.
The findings of the present case suggest that the appearance of HPVG and PCI does not necessarily indicate the presence of intestinal necrosis. Furthermore, in patients with a history of UC who develop infectious colitis, HPVG and PCI may appear because of vulnerability of the colonic mucosa.
