A Case of Pseudomembranous Colitis in a Juvenile Rheumatoid Arthritis Patient Taking Methotrexate

Jihan Yu; Na-Young Kim; Hae-Min Lee; Ha-Ni Lee; Hyo Jun Ahn; Sang-Woo Kim; Kyu-Yong Choi

doi:10.4166/kjg.2010.56.6.387

Journal List > Korean J Gastroenterol > v.56(6) > 1006752

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Yu, Kim, Lee, Lee, Ahn, Kim, and Choi: A Case of Pseudomembranous Colitis in a Juvenile Rheumatoid Arthritis Patient Taking Methotrexate

Original Article

Korean J Gastroenterol 2010;56(6):387-390.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.56.6.387

A Case of Pseudomembranous Colitis in a Juvenile Rheumatoid Arthritis Patient Taking Methotrexate

Jihan Yu, M.D., Na-Young Kim, M.D., Hae-Min Lee, M.D., Ha-Ni Lee, M.D., Hyo Jun Ahn, M.D., Sang-Woo Kim, M.D., Kyu-Yong Choi, M.D.

Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Sang-Woo Kim, M.D. Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505, Banpo-dong, Seocho-gu, Seoul 137-040, Korea Tel: +82-2-2258-2901, Fax: +82-2-599-3589 E-mail: viper@catholic.ac.kr

Received 21 March 2010 Accepted 10 May 2010

Abstract

Pseudomembranous colitis is mainly caused by antibiotics and Clostridium difficile infection. But conditions such as gastrointestinal surgery, antacid medication, anti-neoplastic agent or immunosuppressive agent which influences the normal flora of colon can induce colitis without the administration of any antibiotics. We experienced a 13 year-old male who was taking low-dose methotrexate for juvenile rheumatoid arthritis complained diarrhea and abdominal pain for 3 weeks. Sigmoidoscopic findings revealed diffuse patch yellowish pseudomembranes on the rectum. Histologic finding was compatible to pseudomembranous colitis. His symptom was improved after stop taking methotrexate and the administration of metronidazole. If a patient treated with immunosuppressive agents or antineoplastic agents complains diarrhea, fever or abdominal pain and has not improved with conservative care, pseudomembranous colitis should be taken into account as a differential diagnosis and prompt treatment is required for better prognosis.

Keywords: Pseudomembranous colitis, Methotrexate, Immunosuppressive agents, Chemotherapy, Diarrhea

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Fig. 1.

Enhanced abdominal CT. There was diffuse and edematous bowel wall thickening in the entire colon with well-enhancing mucosal wall.

Fig. 2.

Sigmoidoscopic finding. There were diffusely scattered numerous elevated yellowish plaques with edematous and hypere-mic mucosa.

Fig. 3.

Patholigic finding of biopsy specimen from sigmoid colon mucosa. It showed superficially damaged mucosa with numerous infiltrated lymphocytes and volcano-shaped fibrinopurulent exudates (H&E stain, ×50).

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