Difference between revisions of "Pseudomembranous colitis"

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#redirect [[Colon#Pseudomembranous_colitis]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Colonic_pseudomembranes_intermed_mag.jpg
| Width      =
| Caption    = 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
| Micro      = heaped necrotic surface epithelium (described as "volanco lesions"), [[PMN]]s in lamina propria, +/-capillary fibrin thrombi
| Subtypes  =
| LMDDx      = [[cap polyposis]], [[signet ring cell carcinoma]] (uncommonly), [[ischemic colitis]] in general
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[colon]]
| Assdx      =
| Syndromes  =
| Clinicalhx = +/-prior treatment with antibiotics for something else
| Signs      =
| Symptoms  = diarrhea, abdominal pain, fever
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| 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)
| ClinDDx    =
| Tx        = 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:<ref name=Ref_PBoD837-8>{{Ref PBoD|837-8}}</ref>
*[[C. difficile]].
**Known as ''C. difficile colitis''.
*[[Ischemic colitis]].
**Volvulus.
*Other infections.
 
Etiology:
*Anything that causes a severe mucosal injury.
 
===Clostridium difficile===
{{Main|Clostridium difficile}}
 
Epidemiology of ''[[C. difficile]]'' pseudomembranous colitis:<ref name=pmid23103666>{{Cite journal  | last1 = Jones | first1 = AM. | last2 = Kuijper | first2 = EJ. | last3 = Wilcox | first3 = MH. | title = Clostridium difficile: a European perspective. | journal = J Infect | volume = 66 | issue = 2 | pages = 115-28 | month = Feb | year = 2013 | doi = 10.1016/j.jinf.2012.10.019 | PMID = 23103666 }}</ref>
*Antibiotics prior to onset (classic history).<ref name=pmid23253319>{{Cite journal  | last1 = Bassetti | first1 = M. | last2 = Villa | first2 = G. | last3 = Pecori | first3 = D. | last4 = Arzese | first4 = A. | last5 = Wilcox | first5 = M. | title = Epidemiology, diagnosis and treatment of Clostridium difficile infection. | journal = Expert Rev Anti Infect Ther | volume = 10 | issue = 12 | pages = 1405-23 | month = Dec | year = 2012 | doi = 10.1586/eri.12.135 | PMID = 23253319 }}</ref>
*Typically hospitalized.
*Typically older individuals.
 
Clinical:<ref name=pmid8828001>{{Cite journal  | last1 = Gröschel | first1 = DH. | title = Clostridium difficile infection. | journal = Crit Rev Clin Lab Sci | volume = 33 | issue = 3 | pages = 203-45 | month =  | year = 1996 | doi = 10.3109/10408369609083061 | PMID = 8828001 }}</ref>
*Diarrhea - usu. non-bloody - classic finding.
*+/-Fever.
*+/-Abdominal pain.
 
==Gross==
Features:<ref>URL: [http://radiology.uchc.edu/eAtlas/GI/1749.htm http://radiology.uchc.edu/eAtlas/GI/1749.htm]. Accessed on: 22 May 2012.</ref>
*Pseudomembranes:
**Pale yellow (or white) irregular, raised mucosal lesions.
**Early lesions: typical <10 mm.
*Interlesional mucosa often near normal grossly.
 
===Images===
<gallery>
Image:Pseudomembranous_colitis_1.jpg | Pseudomembranous colitis - endoscopic image. (WC/Samir)
Image:Pseudomembranous_colitis.JPG | Pseudomembranous colitis. (WC/Doc James)
Image:Pseudomembranous_Colitis,_Colectomy_(Gross)_(7410584264).jpg | Pseudomembranous colitis. (WC/Euthman)
</gallery>
 
==Microscopic==
Features:<ref name=Ref_PBoD837-8>{{Ref PBoD|837-8}}</ref>
*Heaped necrotic surface epithelium.
**Described as "volanco lesions" - this is what is seen endoscopically.
*[[PMN]]s in lamina propria.
*+/-Capillary fibrin thrombi.
 
Notes:
*Pseudomembranes arise from the crypts.
*Rarely have (benign) [[signet ring cell]]-like cells.<ref name=pmid12684766>{{Cite journal  | last1 = Abdulkader | first1 = I. | last2 = Cameselle-Teijeiro | first2 = J. | last3 = Forteza | first3 = J. | title = Signet-ring cells associated with pseudomembranous colitis. | journal = Virchows Arch | volume = 442 | issue = 4 | pages = 412-4 | month = Apr | year = 2003 | doi = 10.1007/s00428-003-0779-1 | PMID = 12684766 }}</ref>
 
DDx:
*[[Cap polyposis]] - very rare.
*[[Signet ring cell carcinoma]].
*[[Ischemic colitis]] - in general.
*Pseudomembranes associated with [[collagenous colitis]] - small case series reported.<ref name=pmid14508399>{{Cite journal  | last1 = Yuan | first1 = S. | last2 = Reyes | first2 = V. | last3 = Bronner | first3 = MP. | title = Pseudomembranous collagenous colitis. | journal = Am J Surg Pathol | volume = 27 | issue = 10 | pages = 1375-9 | month = Oct | year = 2003 | doi =  | PMID = 14508399 }}</ref>
 
===Images===
<gallery>
Image:Colonic_pseudomembranes_low_mag.jpg | Pseudomembranes - low mag. (WC/Nephron)
Image:Colonic_pseudomembranes_intermed_mag.jpg | Pseudomembranes - intermed. mag. (WC/Nephron)
</gallery>
www:
*[http://path.upmc.edu/cases/case153.html Pseudomembranous colitis (upmc.edu)].
 
==Sign out==
*It is worth mentioning that ''pseudomembranous colitis'' has a [[differential diagnosis]] when considered from the morphology.
 
==See also==
*[[Ischemic colitis]].
*[[Colon]].
*[[Toxic megacolon]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Colon]]

Latest revision as of 17:50, 14 August 2018

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

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

  • Pseudomembranous colitis - endoscopic image. (WC/Samir)

  • Pseudomembranous colitis. (WC/Doc James)

  • Pseudomembranous colitis. (WC/Euthman)

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

  • Pseudomembranes - low mag. (WC/Nephron)

  • Pseudomembranes - intermed. mag. (WC/Nephron)

www:

Sign out

  • 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.
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