Hospital: 1XABIER LEUNDA AYASTUY, 2H U B U
Aut@r o Autores: X. Leunda Ayastuy, A. Salazar Salgado, P. Velázquez Fragua, A. Lozano Santamaría, G. Vega Muñoz, J. Venegas Gómez.
A 38-year-old women who gave birth five days before started with abdominal pain, diharrea and loose stools. She reported that days before delivery started with that symptomatology and she denied similar cases in relatives. The laboratory tests revealed leukocytosis, neutrophilia and high C-reactive protein. Intravenous contrast-enhanced CT revealed the findings shown in the images. She was diagnosed with probable pseudomembranous colitis and the results of blood cultures confirmed the diagnosis.
Antibiotic use is the most important risk factor for the development of pseudomembranous colitis, nevertheless we must always keep in mind that pregnancy poses a threat. Most cases related to pregnancy are happen after a cesarean delivery, but in this case the delivery was vaginal. During pregnancy immune system will undergo multiple changes, since the celullar immunity is partially deactivated. In theory, cellular immunity shuld act against Clostridium Difficile, but in these cases must act the humoral immunity. In most cases it manages to deal with the bacterial exotoxins but in others, as in our case, it does not. In pseudomembranous colitis we can check different radiological findings none of them being specific to the disease. It produces one of the most severe degrees of wall thickening (average wall thickness: 14.7 mm) among all types of colitis and the enhancement pattern of the wall thickening produces a target sign with enhancing mucosa and low attenuation edematous submucosa . It is possible to see the “thumbprinting sign” that is produced by the irregular mucosal contour with polypoid protrusions. If oral contrast is administrated it is trapped between thickened haustral folds and resembles the appearance of an accordion. Other findings are the presence of ascities and the pericolonic fat stranding (which is very mild compared to parietal thickening).
Althought taking antibiotics is the most frequent cause of pseudomembranous colitis, we must bear in mind that this pathology may appear in patients who have not taken antibiotics for instance critically ill patients, oncological patients, pregnant women…
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