A Case Report of Clostridium D‐l Toxin Positive Colitis with Ischemic Changes after Antibiotic Treatment

Abstract: A 52‐year‐old male was admitted to our hospital complaining of crampy abdominal pain of sudden onset, followed by bloody diarrhea. He had been prescribed cefteram pivoxil for gingivitis three days before the onset. A total colonoscopic examination on admission revealed several shallow longitudinal ulcers and erosions, with erythematous, edematous mucosa and luminal narrowing from the sigmoid to the descending colon. Barium enema showed luminal narrowing and thumbprinting in the same region. Fecal culture for Clostridium difficile (C. difficile) on admission was positive and the D‐1 toxin of C. difficile was strongly positive in stool. Two days after admission, the stool was negative for the D‐1 toxin. Biopsies taken from lesions revealed a desquamation of the surface epithelium and some crypt degeneration, abundant fibrinous exudates in the lamina propria, and mild neutrophilic infiltration. Colonic lesions had resolved by seven days after admission. This case suggests that colitis with ischemic changes may result from antibiotic‐associated overgrowth of C. difficile producing the D‐1 toxin during antibiotic treatment.