Pseudomembranous colitis

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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]

Etiology:

  • Anything that causes a severe mucosal injury.

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:

DDx:

Images

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  • It is worth mentioning that pseudomembranous colitis has a differential diagnosis when considered from the morphology.

See also

References

  1. 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.
  2. 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.
  3. 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.
  4. Gröschel, DH. (1996). "Clostridium difficile infection.". Crit Rev Clin Lab Sci 33 (3): 203-45. doi:10.3109/10408369609083061. PMID 8828001.
  5. URL: http://radiology.uchc.edu/eAtlas/GI/1749.htm. Accessed on: 22 May 2012.
  6. 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.
  7. Yuan, S.; Reyes, V.; Bronner, MP. (Oct 2003). "Pseudomembranous collagenous colitis.". Am J Surg Pathol 27 (10): 1375-9. PMID 14508399.