J Biomed Res.  2014 Mar;15(1):44-48.

A case of pseudomembranous colitis associated with antituberculosis therapy in a patient with tuberculous meningitis

• Kim MJ
• Jeong HW
• Choi YR

Abstract

Pseudomembranous colitis (PMC) is known to be associated with the long-term administration of antibiotics, which alter normal gastrointestinal flora and allow overgrowth of Clostridium difficile. However, antituberculosis agents are rarely reported as a cause of this disease. Besides, most cases of antituberculosis agent-induced PMC have been observed in patients with pulmonary tuberculosis but not with tuberculous meningitis. This report presents a case of PMC associated with antituberculosis therapy in a patient with tuberculous meningitis. A 29-year-old female patient was admitted due to headaches and diplopia that had lasted for 2 weeks. She had not recently received antimicrobial therapy. She was diagnosed with tuberculous meningitis by cerebrospinal fluid findings and neurologic examination, including brain imaging study. She was treated with standard antituberculosis agents (HERZ regimen: isoniazid, ethambutol, rifampicin, and pyrazinamide). After 11 days of HERZ, she developed a fever, sudden widespread skin eruption, and elevation of liver enzymes. Considering adverse drug reactions, antituberculosis agents were stopped. One week later, her symptoms were relieved. Thus, antituberculosis agents were reintroduced one at a time after liver function returned to normal. However, she presented with frequent mucoid, jelly-like diarrhea, and lower abdominal pain. Sigmoidscopy revealed multiple yellowish plaques with edematous mucosa, which were compatible with PMC. She was treated with oral vancomycin considering drug interactions. Symptoms were relieved and did not recur when all antituberculosis agents except pyrazinamide were started again. Therefore, when a patient complains of abdominal pain or diarrhea after initiation of antituberculosis therapy, the physician should consider the possibility of antituberculosis agent-associated PMC.

Keyword

pseudomembranous colitis; Clostridium difficile; tuberculous meningitis; antituberculosis agents; vancomycin

MeSH Terms

Abdominal Pain
Adult
Anti-Bacterial Agents
Cerebrospinal Fluid
Clostridium difficile
Diarrhea
Diplopia
Drug Interactions
Drug-Related Side Effects and Adverse Reactions
Enterocolitis, Pseudomembranous*
Ethambutol
Female
Fever
Headache
Humans
Isoniazid
Liver
Mucous Membrane
Neuroimaging
Neurologic Examination
Pyrazinamide
Rifampin
Skin
Tuberculosis, Meningeal*
Tuberculosis, Pulmonary
Vancomycin
Anti-Bacterial Agents
Ethambutol
Isoniazid
Pyrazinamide
Rifampin
Vancomycin