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A Rare Case of Pseudomembrane-Associated Ulcerative Colitis

Ulcerative colitis (UC) is a chronic, life-long inflammatory bowel disease that normally presents with bloody diarrhea, fever, abdominal pain, and leukocytosis. Diagnosis is usually based on clinical presentation, endoscopy with biopsy, and exclusion of alternative diagnoses. In very rare cases, pseudomembranes may be found on colonoscopy in patients with an early UC flare. Historically, the objective finding of pseudomembranes has been exclusively used to diagnose a Clostridioides difficile infection (CDI); however, diagnostic testing must be correctly utilized to confirm whether a CDI is truly the cause of the presence of pseudomembranes, and not an alternative etiology, such as UC. In this case, we discuss a 43-year-old female who presented to the hospital with worsening chronic bloody diarrhea after being seen in the outpatient clinic for a questionable CDI. She underwent endoscopic evaluation revealing pseudomembranous colitis; however, C. difficile testing showed one positive gastrointestinal (GI) pathogen panel and multiple negative antigens and toxin enzyme immunoassays (EIA). With a clinical suspicion of early UC, the patient was treated with mesalamine enemas and improved clinically before discharge. Several months later, she underwent endoscopic evaluation with biopsy, which showed findings consistent with a diagnosis of UC.

 

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The presence of pseudomembranes on colonoscopy has historically been used to diagnose Clostridioides difficile infection (CDI), but correct diagnostic testing must be used to confirm the cause. In this case, a 43-year-old female with chronic bloody diarrhea was initially evaluated for CDI but had one positive GI pathogen panel and multiple negative antigens and toxin EIA. Endoscopic evaluation revealed pseudomembranous colitis, but clinical suspicion of early ulcerative colitis (UC) led to treatment with mesalamine enemas and improvement. Subsequent endoscopic evaluation with biopsy showed findings consistent with a diagnosis of UC.

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