Pseudomembranous colitis
Jump to navigation
Jump to search
The printable version is no longer supported and may have rendering errors. Please update your browser bookmarks and please use the default browser print function instead.
Pseudomembranous colitis | |
---|---|
Diagnosis in short | |
Colonic pseudomembrane. H&E stain. | |
| |
Synonyms | C. difficile colitis not the same from the perspective of pathology; however, pseudomembranous colitis is commonly used as synonym for C. difficile colitis by clinicians |
| |
LM | heaped necrotic surface epithelium (described as "volanco lesions"), PMNs in lamina propria, +/-capillary fibrin thrombi |
LM DDx | cap polyposis, signet ring cell carcinoma (uncommonly), ischemic colitis in general |
Site | colon |
| |
Clinical history | +/-prior treatment with antibiotics for something else |
Symptoms | diarrhea, abdominal pain, fever |
Prevalence | uncommon |
Endoscopy | pseudomembranes (pale yellow (or white) irregular, raised mucosal lesions), interlesional mucosa often near normal grossly |
Prognosis | dependent on comorbidities |
Other | C. difficile toxin test positive (may be negative) |
Treatment | dependent on underlying cause, antibiotics in C. difficile - occasionally surgical resection |
Pseudomembranous colitis an inflammation of the colon (colitis) with a characteristic endoscopic/gross appearance. It is closely associated with C. difficile infections; however, may be seen in a number of different situations.
General
- Pseudomembranous colitis is a histomorphologic description which has a DDx. In other words, it can be caused by a number of things.
Etiology
DDx of pseudomembranous colitis:[1]
- C. difficile.
- Known as C. difficile colitis.
- Ischemic colitis.
- Volvulus.
- Other infections.
Etiology:
- Anything that causes a severe mucosal injury.
Clostridium difficile
Main article: Clostridium difficile
Epidemiology of C. difficile pseudomembranous colitis:[2]
- Antibiotics prior to onset (classic history).[3]
- Typically hospitalized.
- Typically older individuals.
Clinical:[4]
- Diarrhea - usu. non-bloody - classic finding.
- +/-Fever.
- +/-Abdominal pain.
Gross
Features:[5]
- Pseudomembranes:
- Pale yellow (or white) irregular, raised mucosal lesions.
- Early lesions: typical <10 mm.
- Interlesional mucosa often near normal grossly.
Images
Microscopic
Features:[1]
- Heaped necrotic surface epithelium.
- Described as "volanco lesions" - this is what is seen endoscopically.
- PMNs in lamina propria.
- +/-Capillary fibrin thrombi.
Notes:
- Pseudomembranes arise from the crypts.
- Rarely have (benign) signet ring cell-like cells.[6]
DDx:
- Cap polyposis - very rare.
- Signet ring cell carcinoma.
- Ischemic colitis - in general.
- Pseudomembranes associated with collagenous colitis - small case series reported.[7]
Images
www:
Sign out
- It is worth mentioning that pseudomembranous colitis has a differential diagnosis when considered from the morphology.
See also
References
- ↑ 1.0 1.1 Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 837-8. ISBN 0-7216-0187-1.
- ↑ Jones, AM.; Kuijper, EJ.; Wilcox, MH. (Feb 2013). "Clostridium difficile: a European perspective.". J Infect 66 (2): 115-28. doi:10.1016/j.jinf.2012.10.019. PMID 23103666.
- ↑ Bassetti, M.; Villa, G.; Pecori, D.; Arzese, A.; Wilcox, M. (Dec 2012). "Epidemiology, diagnosis and treatment of Clostridium difficile infection.". Expert Rev Anti Infect Ther 10 (12): 1405-23. doi:10.1586/eri.12.135. PMID 23253319.
- ↑ Gröschel, DH. (1996). "Clostridium difficile infection.". Crit Rev Clin Lab Sci 33 (3): 203-45. doi:10.3109/10408369609083061. PMID 8828001.
- ↑ URL: http://radiology.uchc.edu/eAtlas/GI/1749.htm. Accessed on: 22 May 2012.
- ↑ Abdulkader, I.; Cameselle-Teijeiro, J.; Forteza, J. (Apr 2003). "Signet-ring cells associated with pseudomembranous colitis.". Virchows Arch 442 (4): 412-4. doi:10.1007/s00428-003-0779-1. PMID 12684766.
- ↑ Yuan, S.; Reyes, V.; Bronner, MP. (Oct 2003). "Pseudomembranous collagenous colitis.". Am J Surg Pathol 27 (10): 1375-9. PMID 14508399.