A case of pseudomembranous colitis due to Clostridium difficile and the new th erapeutic approach.
A 5 year 7 months old Japanese girl has been in good health untile 5 days before admission when she started to complain of abdominal pain, high fever, vomiting and generalized convulsion. The initial clinical impression was septicemia. She was given ampicillin 100 mg/kg and gentamycin 5 mg/kg. On the 5th hospital day severe colic and watery stools with blo od developed. The leukocytecount was 15, 400/cmm with 90% neutrophiles. The hemoglobin was 10.4 g/dl, serum protain 3.8 g/dl and albumin 1.99 g/dl. Blood and albumin transfusions were performed but the hypoalb uminemia and anemia persisted. The Gordon test was 2.8%. An X-ray film of the abdomen showed thumbprinting, and a scintigram of abdomen ruled out hemorrhagc gastroduodenitis and Meckel's diverticulitis. The proctosigmoidoscopy revealed an edemato us mucosa with white-yellow plaques indicating PMC. Administration of antibiotics was stopped. The plasma FDP was above 40 μg/ml and the thrombocyte count remained 30.5 × 104/cmm. The plasma factor XIII level was 42%, but the plasma plasmin activity, fibrinogen, bleeding time, coagulation time were normal
A total of 1250 units (5 vials) of factor XIII concentrate (Behringwe rke-Hoechst) was administered in 3 days. The abdominal pains subsided and the bowel movement became normal.
Clostridium difficile of over 108/g were found in the stool on the 7th hospital day. Heat labile enterotoxin to the mouse Y-1 adrenal cell was also demonstrated
These results suggests that treatment with factor XIII offers a new possibility of controlling severe hemorrhagic diarrhea in antibiotics-associated PMC.
