Yonsei Med J.  2011 Sep;52(5):863-865. 10.3349/ymj.2011.52.5.863.

A Case of Pseudomembranous Colitis after Voriconazole Therapy

• Kwon JC
• Kang MK
• Kim SH
• Choi SM
• Kim HJ
• Min WS
• Lee DG

• KMID: 1108083
• DOI: http://doi.org/10.3349/ymj.2011.52.5.863

Abstract

This is a case report on a 35-year-old man with acute myelogenous leukemia who presented fever and intermittent mucoid loose stool to the emergency center. He had been taking voriconazole for invasive pulmonary aspergillosis. The flexible sigmoidoscopy was consistent with the diagnosis of pseudomembranous colitis.

Keyword

Pseudomembranous colitis; voriconazole; diarrhea; Clostridium difficile

MeSH Terms

Adult
Antifungal Agents/*adverse effects
Enterocolitis, Pseudomembranous/*chemically induced/pathology
Humans
Invasive Pulmonary Aspergillosis/complications/drug therapy
Leukemia, Myeloid, Acute/complications
Male
Opportunistic Infections/complications/drug therapy
Pyrimidines/*adverse effects
Triazoles/*adverse effects

Figure

• 

  Fig. 1 Flexible sigmoidoscopy revealed mucosal edema and yellowish exudative plaques.

• 

  Fig. 2 Biopsy showed volcano-like eruptions with superficial pseudomembrane formation adjacent to an area of mucosal necrosis and superficial erosions.

Reference

1. Coté GA, Buchman AL. Antibiotic-associated diarrhoea. Expert Opin Drug Saf. 2006. 5:361–372.

2. Nguyen AJ, Nelson DB, Thurn JR. Pseudomembranous colitis after itraconazole therapy. Am J Gastroenterol. 1999. 94:1971–1973.

3. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981. 30:239–245.

4. Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet. 2000. 356:1255–1259.

5. Bergogne-Bérézin E. Treatment and prevention of antibiotic associated diarrhea. Int J Antimicrob Agents. 2000. 16:521–526.

6. Kelly CP, LaMont JT. Clostridium difficile infection. Annu Rev Med. 1998. 49:375–390.

7. Miller M, Gravel D, Mulvey M, Taylor G, Boyd D, Simor A, et al. Health care-associated Clostridium difficile infection in Canada: patient age and infecting strain type are highly predictive of severe outcome and mortality. Clin Infect Dis. 2010. 50:194–201.

8. Högenauer C, Hammer HF, Krejs GJ, Reisinger EC. Mechanisms and management of antibiotic-associated diarrhea. Clin Infect Dis. 1998. 27:702–710.

9. Johnson LB, Kauffman CA. Voriconazole: a new triazole antifungal agent. Clin Infect Dis. 2003. 36:630–637.

10. Drug information. Available from: URL:http://www.pfizer.com/files/products/uspi_vfend.pdf.

11. Cohen R, Roth FJ, Delgado E, Ahearn DG, Kalser MH. Fungal flora of the normal human small and large intestine. N Engl J Med. 1969. 280:638–641.

12. Heard SR, Wren B, Barnett MJ, Thomas JM, Tabaqchali S. Clostridium difficile infection in patients with haematological malignant disease. Risk factors, faecal toxins and pathogenic strains. Epidemiol Infect. 1988. 100:63–72.