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Lee, Woo, Park, Hong, Lee, and Woo: Clostridium difficile Colitis after Topical Ophthalmic Use of Levofloxacin
Case Report

The Ewha Medical Journal 2013; 36(Suppl): S5-S8.

Published online: 23 December 2013

DOI: https://doi.org/10.12771/emj.2013.36.S.S5

Clostridium difficile Colitis after Topical Ophthalmic Use of Levofloxacin

Jang Wook Lee, Seong Yong Woo, Suk Joon Park, Seung Hyun Hong, Sung Yun Lee, Seung Min Woo

Department of Internal Medicine, Daerim Saint Mary's Hospital, Seoul, Korea.

Corresponding author: Seong Yong Woo. Department of Internal Medicine, Daerim Saint Mary's Hospital, 657, Siheung-daero, Yeongdeungpo-gu, Seoul 150-822, Korea. Tel: 82-2-829-9301, Fax: 82-2-829-9299, loveandy@hanmail.net

Received 12 June 2013       Accepted 2 July 2013

Copyright © 2013. Ewha Womans University School of Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Clostridium difficile colitis (CDC) has been associated with virtually all available antibiotics. It is well known that administration of drugs by the ocular route can result in systemic absorption with the possibility of systemic effect. We report a case of a 74-year-old woman who was treated with 0.5% levofloxacin eyedrops for ten weeks running for the post operative management of two separate bilateral cataract surgeries. Toxin assay for C. difficile was positive and the endoscopic findings were compatible with CDC. The plasma concentrations reached after intraocular administration of levofloxacin seem so trivial, but the administration of topical agents could make accumulated effect and be a potential cause of systemic toxicity.

Keywords: Clostridium difficile, Enterocolitis, Levofloxacin, Ophthalmic solutions

Figures and Tables

Fig. 1
Abdominal computed tomography findings. They show diffuse edematous wall thickenings (white arrows) of the entire colon (A, B).
emj-36-S5-g001
Fig. 2
Sigmoidoscopic finding. It shows multiple yellowish plaques with erythematous and edematous mucosa in the sigmoid colon.
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Fig. 3
Pathologic finding of biopsy specimen from colon mucosa. It shows severe erosion with pseudomembrane composed of fibrinous neutrophilic exudates (white circle) (H&E, ×100).
emj-36-S5-g003
Fig. 4
Follow-up endoscopic finding. It shows a nearly improved state of colitis with no pseudomembrane.
emj-36-S5-g004

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