3.A Case of Methicillin Resistant Staphylococcus Aureus Enterocolitis Presenting with Massive Diarrhea.
Hang Lak LEE ; Dong Soo HAN ; Jong Pyo KIM ; Jin Bae KIM ; Joon Yong PARK ; Joo Hyun SOHN ; Joon Soo HAHM
The Korean Journal of Gastroenterology 2003;42(3):246-248
Methicillin resistant Staphylococcal aureus (MRSA) enterocolitis is characterized by high fever, abdominal distension, and watery diarrhea that leads to severe dehydration, shock, a sharp decrease in the white cell counts and sometimes multiple organ failure. Clinically, it can be an another cause of nosocomial diarrhea. If MRSA enteritis is suspected from the clinical symptoms, prompt treatment and strict prophylactic measures including vancomycin, are most important for its management. We recently observed a case of MRSA enterocolitis as a nosocomial infection in a patient with acute pancreatitis. This patient showed uncontrolled massive diarrhea, fever, and multiple organ failure. We report a case of MRSA enterocolitis with a review of literatures.
Cross Infection/diagnosis/*microbiology
;
Diarrhea/etiology/*microbiology
;
Enterocolitis/complications/diagnosis/*microbiology
;
Humans
;
Male
;
*Methicillin Resistance
;
Middle Aged
;
*Staphylococcal Infections/diagnosis
4.A Case of Sepsis and Acute Renal Failure Associated with Salmonella Enterocolitis.
Chul Han KIM ; Ki Tae SUK ; Jae Woo KIM
The Korean Journal of Gastroenterology 2008;52(2):110-114
Salmonella infection can cause an asymptomatic intestinal carrier state or clinical diseases such as enterocolitis presenting abdominal pain, fever, vomiting, or diarrhea. Salmonella usually invades Peyer's patch of terminal ileum or ascending colon. Sepsis is not common and acute renal failure secondary to rhabdomyolysis is rare. The causes of rhabdomyolysis are trauma, excessive exercise, alcohol, seizure, metabolic abnormality, and infection. Infections account for less than 5% of the reported causes of rhabdomyolysis and resulting acute renal failure. The mechanisms underlying rhabdomyolysis due to infection are direct muscle invasion, toxin production, and nonspecific effects that can occur with infections such as fever, dehydration, acidosis, and electrolyte imbalance. We report a case of sepsis and acute renal failure secondary to rhabdomyolysis associated with Salmonella infection.
Colonoscopy
;
Enterocolitis/complications/*diagnosis
;
Humans
;
Kidney Failure, Acute/*diagnosis/etiology
;
Male
;
Middle Aged
;
Rhabdomyolysis/diagnosis/etiology/microbiology
;
Salmonella Infections/complications/*diagnosis
;
Sepsis/*diagnosis/etiology
;
Tomography, X-Ray Computed
5.A Case of Pseudomembranous Colitis Associated with Rifampicin Therapy in a Patient with Rectal Cancer and Gastrointestinal Tuberculosis.
Yong Jun CHOI ; Hyung Gil KIM ; Yun Ah CHOI ; Woo Chul JOO ; Dong Wook SON ; Chul Hyun KIM ; Yong Woon SHIN ; Young Soo KIM
The Korean Journal of Gastroenterology 2009;53(1):53-56
Pseudomembranous colitis (PMC) is known to be associated with the administration of antibiotics which alter normal gastrointestinal flora and allow overgrowth of Clostridium difficile. Most cases of rifampicin-induced PMC are seen in patients with pulmonary tuberculosis, but not with gastrointestinal tuberculosis. We report a case of PMC associated with rifampicin therapy in a patient with gastrointestinal tuberculosis. A 65-year-old female patient with rectal cancer and gastrointestinal tuberculosis was admitted due to abdominal pain and diarrhea. She was treated with anti-tuberculosis agents containing rifampicin. On colonoscopic examination, mucoid exudates and yellowish plaque lesions were observed. Anti-tuberculosis agents were stopped, and the patient was treated with metronidazole. Symptoms were relieved and did not recur when all the anti-tuberculosis agents except rifampicin were started again. When a patient complains of abdominal pain or diarrhea while taking rifampicin, the physician should consider the possibility of rifampicin-associated PMC.
Aged
;
Antibiotics, Antitubercular/*adverse effects/therapeutic use
;
Enterocolitis, Pseudomembranous/*diagnosis/etiology/pathology
;
Female
;
Humans
;
Rectal Neoplasms/*complications/diagnosis
;
Rifampin/*adverse effects/therapeutic use
;
Sigmoidoscopy
;
Tuberculosis, Gastrointestinal/complications/diagnosis/*drug therapy
6.Advanced chronic kidney disease: a strong risk factor for Clostridium difficile infection.
Sun Chul KIM ; Min Young SEO ; Jun Yong LEE ; Ki Tae KIM ; Eunjung CHO ; Myung Gyu KIM ; Sang Kyung JO ; Won Yong CHO ; Hyoung Kyu KIM
The Korean Journal of Internal Medicine 2016;31(1):125-133
BACKGROUND/AIMS: It has been suggested that chronic kidney disease (CKD) is a risk factor for Clostridium difficile infection (CDI) and is associated with increased mortality among patients infected with C. difficile. However, recent studies of the clinical impact of CKD on CDI in Asians are still insufficient. We sought to determine the relationship between CKD and CDI in a Korean population. METHODS: This was a single-center, retrospective case-control study. In total, 171 patients with CDI were included as cases and 342 age- and gender-matched patients without CDI were used as controls. We compared the prevalence of CKD in the study sample and identified independent risk factors that could predict the development or prognosis of CDI. RESULTS: Independent risk factors for CDI included stage IV to V CKD not requiring dialysis (odds ratio [OR], 2.90) and end-stage renal disease requiring dialysis (OR, 3.34). Patients with more advanced CKD (estimated glomerular filtration rate < 30) and CDI showed higher in-hospital mortality and poorer responses to the initial metronidazole therapy. CONCLUSIONS: More advanced CKD is an independent risk factor for CDI and is associated with higher in-hospital mortality and poor treatment responses in CDI patients. Thus, in CKD patients, careful attention should be paid to the occurrence of CDI and its management to improve the outcome of CDI.
Aged
;
Anti-Infective Agents/therapeutic use
;
Chi-Square Distribution
;
Clostridium difficile/*pathogenicity
;
Enterocolitis, Pseudomembranous/diagnosis/drug therapy/*microbiology/mortality
;
Female
;
Hospital Mortality
;
Humans
;
Kidney Failure, Chronic/*complications/diagnosis/therapy
;
Logistic Models
;
Male
;
Metronidazole/therapeutic use
;
Middle Aged
;
Multivariate Analysis
;
Odds Ratio
;
Prevalence
;
Renal Dialysis
;
Renal Insufficiency, Chronic/*complications/diagnosis/mortality/therapy
;
Republic of Korea/epidemiology
;
Retrospective Studies
;
Risk Factors
;
Treatment Outcome
7.Neutropenic Enterocolitis with Liver Abscess in a Young Patient with Leukemia after Chemotherapy.
Hyung Seok PARK ; Seung Hyun LEE ; Byung Kwon AHN ; Sung Uhn BAEK ; Jae Sun PARK
Journal of the Korean Surgical Society 2004;67(2):171-174
Neutropenic enterocolitis is a serious complication of chemotherapy for malignancies such as acute leukemia or lymphoma. The acute inflammatory disease may involve the terminal ileum, cecum and ascending colon. Although conservative care is recommended as the primary treatment modality, surgical intervention is essential for intestinal perforations, abscesses, or bleeding. We experienced a case of neutropenic enterocolitis with a liver abscess in a young leukemia patient. A 13-year-old boy with acute myelogenous leukemia had completed two cycles of chemotherapy (Arabinoside 300 mg, Dactinomycin 40 mg, VP-16 150 mg, 6- mercaptopurin 60 mg, dexametasone 3 mg). Ten days after completing the second cycle he had abdominal pain, low abdominal tenderness and a high fever. The WBC count in the peripheral blood was 210 cell/mm3. A CT scan demonstrated wall thickening of the terminal ileum and ascending colon, as well as 5 cm, and 6 cm sized homogeneous low-density areas in both hepatic lobes. A presumptive diagnosis was neutropenic enterocolitis with a liver abscess. The patient was managed conservatively with fluid resuscitation, a bowel rest, and broad-spectrum antibiotics. Twenty-five days later his abdominal pain was abruptly aggravated. The CT scan and Chest X-ray demonstrated free air in the peritoneal cavity. An emergency laparotomy was performed under a diagnosis of peritonitis with an intestinal perforation. The laparotomy show that, there were perforations at the pylorus of the stomach, and full thickness necrosis at multiple segments of the small bowel. Primary closure of the stomach, a segmental resection and an end-to-end anastomosis of the small bowel, and ileostomy were performed. However, postoperative leakage developed at the stomach. The patient recovered with supportive management. The patient had a third chemotherapy series 3 months after surgery. Three days after completing the third cycle, the patient developed peritonitis. A pyloric re-perforation of the stomach was observed on the laparotomy. Postoperative leakage developed after the primary closure of the stomach. The patient died of sepsis 54 days later. Therefore, intensive monitoring and close collaboration between the hematologist and the surgeon is essential for patients with neutropenic enterocolitis. Postoperative complications are quite common and can be fatal in patients with neutropenic enterocolitis that develops after chemotherapy.
Abdominal Pain
;
Abscess
;
Adolescent
;
Anti-Bacterial Agents
;
Cecum
;
Colon, Ascending
;
Cooperative Behavior
;
Dactinomycin
;
Diagnosis
;
Drug Therapy*
;
Emergencies
;
Enterocolitis, Neutropenic*
;
Etoposide
;
Fever
;
Hemorrhage
;
Humans
;
Ileostomy
;
Ileum
;
Intestinal Perforation
;
Laparotomy
;
Leukemia*
;
Leukemia, Myeloid, Acute
;
Liver Abscess*
;
Liver*
;
Lymphoma
;
Male
;
Necrosis
;
Peritoneal Cavity
;
Peritonitis
;
Postoperative Complications
;
Pylorus
;
Resuscitation
;
Sepsis
;
Stomach
;
Thorax
;
Tomography, X-Ray Computed
8.Neutropenic Enterocolitis with Liver Abscess in a Young Patient with Leukemia after Chemotherapy.
Hyung Seok PARK ; Seung Hyun LEE ; Byung Kwon AHN ; Sung Uhn BAEK ; Jae Sun PARK
Journal of the Korean Surgical Society 2004;67(2):171-174
Neutropenic enterocolitis is a serious complication of chemotherapy for malignancies such as acute leukemia or lymphoma. The acute inflammatory disease may involve the terminal ileum, cecum and ascending colon. Although conservative care is recommended as the primary treatment modality, surgical intervention is essential for intestinal perforations, abscesses, or bleeding. We experienced a case of neutropenic enterocolitis with a liver abscess in a young leukemia patient. A 13-year-old boy with acute myelogenous leukemia had completed two cycles of chemotherapy (Arabinoside 300 mg, Dactinomycin 40 mg, VP-16 150 mg, 6- mercaptopurin 60 mg, dexametasone 3 mg). Ten days after completing the second cycle he had abdominal pain, low abdominal tenderness and a high fever. The WBC count in the peripheral blood was 210 cell/mm3. A CT scan demonstrated wall thickening of the terminal ileum and ascending colon, as well as 5 cm, and 6 cm sized homogeneous low-density areas in both hepatic lobes. A presumptive diagnosis was neutropenic enterocolitis with a liver abscess. The patient was managed conservatively with fluid resuscitation, a bowel rest, and broad-spectrum antibiotics. Twenty-five days later his abdominal pain was abruptly aggravated. The CT scan and Chest X-ray demonstrated free air in the peritoneal cavity. An emergency laparotomy was performed under a diagnosis of peritonitis with an intestinal perforation. The laparotomy show that, there were perforations at the pylorus of the stomach, and full thickness necrosis at multiple segments of the small bowel. Primary closure of the stomach, a segmental resection and an end-to-end anastomosis of the small bowel, and ileostomy were performed. However, postoperative leakage developed at the stomach. The patient recovered with supportive management. The patient had a third chemotherapy series 3 months after surgery. Three days after completing the third cycle, the patient developed peritonitis. A pyloric re-perforation of the stomach was observed on the laparotomy. Postoperative leakage developed after the primary closure of the stomach. The patient died of sepsis 54 days later. Therefore, intensive monitoring and close collaboration between the hematologist and the surgeon is essential for patients with neutropenic enterocolitis. Postoperative complications are quite common and can be fatal in patients with neutropenic enterocolitis that develops after chemotherapy.
Abdominal Pain
;
Abscess
;
Adolescent
;
Anti-Bacterial Agents
;
Cecum
;
Colon, Ascending
;
Cooperative Behavior
;
Dactinomycin
;
Diagnosis
;
Drug Therapy*
;
Emergencies
;
Enterocolitis, Neutropenic*
;
Etoposide
;
Fever
;
Hemorrhage
;
Humans
;
Ileostomy
;
Ileum
;
Intestinal Perforation
;
Laparotomy
;
Leukemia*
;
Leukemia, Myeloid, Acute
;
Liver Abscess*
;
Liver*
;
Lymphoma
;
Male
;
Necrosis
;
Peritoneal Cavity
;
Peritonitis
;
Postoperative Complications
;
Pylorus
;
Resuscitation
;
Sepsis
;
Stomach
;
Thorax
;
Tomography, X-Ray Computed