Pediatr Gastroenterol Hepatol Nutr.  2018 Apr;21(2):141-146. 10.5223/pghn.2018.21.2.141.

Antibiotics-Associated Hemorrhagic Colitis Caused by Klebsiella oxytoca: Two Case Reports

• Youn Y
• Lee SW
• Cho HH
• Park S
• Chung HS
• Seo JW

• KMID: 2409366
• DOI: http://doi.org/10.5223/pghn.2018.21.2.141

Abstract

Nowadays, Klebsiella oxytoca is described as a causative organism for antibiotic-associated hemorrhagic colitis (AAHC). Here we report two cases of pediatric AAHC, from which K. oxytoca was cultured after starting amoxicillin-clavulanate or amoxicillin treatment. The patients developed severe abdominal pain and a large amount of bloody diarrhea. K. oxytoca was obtained in intestinal fluid culture of a boy through the colonoscopy. On the other hand, colonic tissue culture and intestinal fluid culture were negative of the other patient. K. oxytoca was detected in stool culture when he was admitted. These cases showed characteristic endoscopic findings of segmental hemorrhagic colitis, and both boys recovered spontaneously within 2-3 days after they stopped taking the antibiotics. Therefore, in children who develop relatively large amount of bloody diarrhea after antibiotic treatment, we should consider AAHC caused by K. oxytoca.

Keyword

Antibiotic-associated diarrhea; Klebsiella oxytoca; Bloody diarrhea

MeSH Terms

Abdominal Pain
Amoxicillin
Anti-Bacterial Agents
Child
Colitis*
Colon
Colonoscopy
Diarrhea
Hand
Humans
Klebsiella oxytoca*
Klebsiella*
Male
Amoxicillin
Anti-Bacterial Agents

Figure

• 

  Fig. 1 An abdominal computed tomography scan image revealed colitis involving from the ascending colon to the splenic flexure of the colon with the edematous bowel wall thickening (Case 1). A: ascending colon, D: desending colon, T: transverse colon.

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  Fig. 2 A colonoscopy revealed red mucosa and granular erosions with edema from the proximal colon (A) to the distal colon (B). In the hepatic flexure area was the most severe erythema and hemorrhage, friable mucosa and granular erosions with exudate (Case 1): a colonoscopy showed severe redness and hemorrhage in the proximal colon (C) to the distal colon (D) (Case 2).

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  Fig. 3 Photomicrographs of the H&E stained biopsy specimens from the colon of the patient 1 showing: (A) hyalinized lamina propria with hemorrhage and neutrophilic infiltration, reactive epithelial atypia, and cryptitis (H&E, ×200). (B) Neutrophilic cryptitis with mitosis and reactive atypia in the background of preserved crypt architecture (H&E, ×400).

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  Fig. 4 Abdominal computed tomography showed pancolitis with edematous wall thickening and pericolic infiltration. A: ascending colon, D: desending colon, T: transverse colon.

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  Fig. 5 H&E stained biopsy specimens from the ascending colon of the patient 2 showing: (A) hyalinized lamina propria with hemorrhage and neutrophilic infiltration (H&E, ×200). (B) Neutrophilic cryptitis with crypt abscess and eosinophilic infiltration (H&E, ×400).

Reference

1. Bartlett JG. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med. 2002; 346:334–339.

2. Toffler RB, Pingoud EG, Burrell MI. Acute colitis related to penicillin and penicillin derivatives. Lancet. 1978; 2:707–709.

3. Hoffmann KM, Deutschmann A, Weitzer C, Joainig M, Zechner E, Högenauer C, et al. Antibiotic-associated hemorrhagic colitis caused by cytotoxin-producing Klebsiella oxytoca. Pediatrics. 2010; 125:e960–e963.

4. Sakurai Y, Tsuchiya H, Ikegami F, Funatomi T, Takasu S, Uchikoshi T. Acute right-sided hemorrhagic colitis associated with oral administration of ampicillin. Dig Dis Sci. 1979; 24:910–915.

5. Beaugerie L, Metz M, Barbut F, Bellaiche G, Bouhnik Y, Raskine L, et al. Klebsiella oxytoca as an agent of antibiotic-associated hemorrhagic colitis. Clin Gastroenterol Hepatol. 2003; 1:370–376.

6. Yonei Y, Yoshizaki Y, Tsukada N, Inagaki Y, Miyamoto K, Suzuki O, et al. Microvascular disturbances in the colonic mucosa in antibiotic-associated haemorrhagic colitis: involvement of platelet aggregation. J Gastroenterol Hepatol. 1996; 11:681–685.

7. Högenauer C, Langner C, Beubler E, Lippe IT, Schicho R, Gorkiewicz G, et al. Klebsiella oxytoca as a causative organism of antibiotic-associated hemorrhagic colitis. N Engl J Med. 2006; 355:2418–2426.

8. Dietrich CF, Lembcke B, Seifert H, Caspary WF, Wehrmann T. Ultrasound diagnosis of penicillin-induced segmental hemorrhagic colitis. Dtsch Med Wochenschr. 2000; 125:755–760.

9. Högenauer C, Hinterleitner T. Klebsiella oxytoca as a cause of antibiotic-associated colitis. Washington, DC: ASM Press;2008. p. 293–311.

10. Murphy MS. Management of bloody diarrhoea in children in primary care. BMJ. 2008; 336:1010–1015.

11. Bellaïche G, Le Pennec MP, Choudat L, Ley G, Slama JL. Value of rectosigmoidoscopy with bacteriological culture of colonic biopsies in the diagnosis of post-antibiotic hemorrhagic colitis related to Klebsiella oxytoca. Gastroenterol Clin Biol. 1997; 21:764–767.

12. Youngster I, Avorn J, Belleudi V, Cantarutti A, Díez-Domingo J, Kirchmayer U, et al. Antibiotic use in children-a cross-national analysis of 6 countries. J Pediatr. 2017; 182:239–244.