P3100 - Unveiling the Unforeseen: A Singular Dose of Ancef Unleashing Fulminant Pseudomembranous Colitis

Steven Velez, MD¹, Paloma Velasco, MD², Frances Ailis Gonzalez-Reyes, MD^1
1University of Puerto Rico, San Juan, Puerto Rico; ²University of Puerto Rico, Guaynabo, Puerto Rico

Introduction: Clostridium difficile affects 500,000 individuals per year, with 5.8% leading to death. Cases of Cefazolin-induced Clostridium difficile colitis have been reported following at least 3-6 days of therapy. Here we present a rare incident of fulminant colitis following a singular dose of prophylactic Cefazolin.

Case Description/Methods: A 55 year old female patient with a past medical history of Hypothyroidism presented with a left femur fracture requiring surgical intervention and a prophylactic dose of 1 gram of Cefazolin. Internal Medicine service was consulted on post-operative day 3 due to abdominal pain with distention, and malodorous diarrhea. Physical examination disclosed diffuse abdominal tenderness, tympanic percussion, decreased bowel sounds, borderline hypotension, and tachycardia. Laboratory workup showed severe leukocytosis, reactive thrombocytosis, impaired renal function, azotemia, and lactic acidosis. Imaging revealed diffuse concentric bowel wall edema and continuous colo-rectal mucosal hyper-enhancement. Oral Vancomycin and supportive therapy were initiated. Surgery service was consulted due to suspicion of rapidly evolving fulminant colitis and toxic megacolon due to worsening abdominal distention with rigidity, hemodynamic instability, and altered mental status in less than 10 hours since the onset of symptoms. Clinical deterioration ensued with a 5-minute ACLS, respiratory failure requiring mechanical ventilation, septic shock requiring vasopressor therapy, and end-organ failure. Emergent colectomy with end ileostomy was successfully performed with an accompanying pathology report consistent with pseudomembranous colitis throughout the 133cm of the excised colon. Despite aggressive medical therapy, the patient’s clinical status quickly worsened leading to the patient’s demise.

Discussion: Emergent diagnosis, aggressive treatment, and early surgical evaluation are crucial to ensure survival in fulminant clostridium difficile colitis, especially in patients with negligible risk factors such as post-operative opioid use, and pre-operative prophylactic antibiotic dose. This case demarcates the importance of highlighting the associations of standard prophylactic antibiotic practice with C. difficile colitis, and the complications that may arise.


Disclosures:


Steven Velez, MD¹, Paloma Velasco, MD², Frances Ailis Gonzalez-Reyes, MD¹. P3100 - Unveiling the Unforeseen: A Singular Dose of Ancef Unleashing Fulminant Pseudomembranous Colitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.