Abstract
A 78-year-old man was diagnosed with recurrent lung cancer and chemotherapy was initiated in March 2008. The patient developed concomitant interstitial pneumonia during the third course of chemotherapy. Steroid pulse therapy was thus started. During the steroid therapy, he had the sudden onset of frequent diarrhea and abdominal pain. When he was first seen, severe rebound tenderness and muscular guarding were noted over the entire abdomen. Abdominal CT scan revealed marked thickening of the intestinal tract wall and the surrounding fluffy adipose tissue of the sigmoid colon. Lower gastrointestinal perforation was suspected and an emergency operation was performed. Laparotomy revealed a perforation of the sigmoid colon on the opposite side of the mesocolon. Hartmann's operation was conducted to avoid suture rupture. Sigmoid diverticular perforation and pseudomembranous enterocolitis were detected on histopathological examination of the resected specimens. Immediately after the operation, the patient was treated with oral metronidazole that led to temporal symptomatic remission. However, the symptoms recurred and the patient died approximately 1 month after the emergency operation.
Pseudomembranous colitis (PMC) is frequently associated with Clostridium difficile-associated diarrhea and is mostly triggered by antibacterial therapy. However, much attention should be paid to the fact that the intestinal flora is likely to alter easily without involvement of antibiotics in patients in an immunosuppressive condition like those undergoing steroid pulse therapy. Physicians should be aware of this complication when administering similar treatments.
