Ewha Med J.  2014 Mar;37(1):52-55. 10.12771/emj.2014.37.1.52.

Toxic Megacolon Associated with Secondary Amyloidosis: An Unusual Complication of Clostridium difficile Colitis

• Cho HW
• Jung HK
• Kang HJ
• Lee YP
• Kang HW
• Shim KN
• Jung SA

• KMID: 2171275
• DOI: http://doi.org/10.12771/emj.2014.37.1.52

Abstract

Amyloidosis is characterized by extracellular deposition of protein fibrils in one or multiple organs. AA amyloidosis is secondarily occurred to be related with chronic infections or inflammatory diseases. We report a 67-year-old man suffered from secondary AA amyloidosis related with chronic Clostridium difficile colitis after repeated total hip replacement surgery. Infection control is the most important treatment of AA amyloidosis secondary to chronic infection. However, the patient's C. difficile colitis was not controlled well, eventually toxic megacolon with sepsis was developed. Consequently, he had to take total colectomy, but he expired with multi-organ failures. We suggested that early surgical procedure might be one option for intractable C. difficile colitis complicated with secondary amyloidosis.

Keyword

Clostridium difficile; Colitis; Toxic megacolon; Amyloidosis

MeSH Terms

Aged
Amyloidosis*
Arthroplasty, Replacement, Hip
Clostridium difficile*
Clostridium*
Colectomy
Colitis*
Humans
Infection Control
Megacolon, Toxic*
Sepsis

Figure

• 

  Fig. 1 Simple abdominal X-ray of consultation day. The film reveals dilatation of colon.

• 

  Fig. 2 Computed tomography of abdomen-pelvis. It shows edematous wall thickening with layered appearance from transverse colon to rectum with small ascites in pericolic area.

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  Fig. 3 Sigmoidoscopic finding. Sigmoidoscopy shows that normal colonic vasculature is disappeared and multiple erythematous erosions and atrophic changes are noted in colonic mucosa.

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  Fig. 4 Histopathologic fingings. (A) Congo-red stain reveals apple green birefringence in colonic stroma, compatible with amyloidosis (×100). (B) Immunohistochemical stain shows that amyloid A is strongly positive (×40).

Reference

1. Glenner GG. Amyloid deposits and amyloidosis: the beta-fibril-loses (first of two parts). N Engl J Med. 1980; 302:1283–1292.

2. Ku JR, Kim A, Hur Y, Suh DW, Park KH, Kim EJ, et al. A case of protein-losing gastroenteropathy due to secondary gastrointestinal amyloidosis in a patient with rheumatoid arthritis. Korean J Med. 1997; 53:S840–S845.

3. Hunter AM, Borsey DQ, Campbell IW, Macaulay RA. Protein-losing enteropathy due to gastro-intestinal amyloidosis. Postgrad Med J. 1979; 55:822–823.

4. Lee MH, Park WD, Kim BH, Lee JI, Chang YW, Chang R, et al. Generalized primary amyloidosis with malabsorption syndrome. Korean J Gastrointest Endosc. 1987; 7:91–96.

5. Kim JS, Kwon SY, Song GG, Shin SW, Kim JS, Bak YT, et al. A case of systemic amyloidosis with intestinal pseudoobstruction. Korean J Gastrointest Endosc. 1993; 13:375–379.

6. Riemann JF, Schmidt H. Ultrastructural changes in the gut autonomic nervous system following laxative abuse and in other conditions. Scand J Gastroenterol Suppl. 1982; 71:111–124.

7. Bartlett JG, Moon N, Chang TW, Taylor N, Onderdonk AB. Role of Clostridium difficile in antibiotic-associated pseudomembranous colitis. Gastroenterology. 1978; 75:778–782.

8. Koh DH, Lee HL, Kim JM, Moon W, Lee OY, Yoon BC, et al. A case of toxic megacolon associated with fulminant pseudomembranous colitis. Korean J Gastrointest Endosc. 2008; 36:112–116.

9. Redelings MD, Sorvillo F, Mascola L. Increase in Clostridium difficile-related mortality rates, United States, 1999-2004. Emerg Infect Dis. 2007; 13:1417–1419.

10. Chang J, Rohwer RG. Clostridium difficile infection in adult hamsters. Lab Anim Sci. 1991; 41:548–552.

11. Longo WE, Mazuski JE, Virgo KS, Lee P, Bahadursingh AN, Johnson FE. Outcome after colectomy for Clostridium difficile colitis. Dis Colon Rectum. 2004; 47:1620–1626.

12. Dallal RM, Harbrecht BG, Boujoukas AJ, Sirio CA, Farkas LM, Lee KK, et al. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg. 2002; 235:363–372.

13. Morris JB, Zollinger RM Jr, Stellato TA. Role of surgery in antibiotic-induced pseudomembranous enterocolitis. Am J Surg. 1990; 160:535–539.