title: Postoperative Clostridium difficile pseudomembranous colitis in idiopathic scoliosis. A brief clinical report.
abstract: The authors report two healthy young patients with progressive idiopathic scoliosis, both without allergies or histories of gastrointestinal disorders, who received perioperative preventive cephalosporin antibiotics, and developed explosive diarrhea postoperatively, confirmed as Clostridium difficile pseudomembranous colitis by stool toxin assay. Both patients had initially recovered uneventfully after posterior fusion and Cotrel-Dubousset instrumentation. Their youth, health, diagnosis, and lack of nosocomial factors made colitis unexpected. The two cases were sporadic, occurring 2 years apart over a 12-year observation period. Symptoms and signs of colitis for the two patients were markedly varied as to time of onset, order of appearance, and severity. Unexplained fever before onset of diarrhea led to renewed cephalosporin administration, potentially exacerbating the colitis. Initial symptoms and signs were nonspecific; appropriate treatment had to begin before diagnosis could be confirmed by stool toxin asay, which requires 2 days.
authors.affiliation: St. Luke's Memorial Hospital, Spokane, Washington.
authors.forename: W R
authors.initials: WR
authors.lastname: Osebold
authors.forename: A N
authors.initials: AN
authors.lastname: Cohen
authors.forename: M D
authors.initials: MD
authors.lastname: Gillum
authors.forename: J H
authors.initials: JH
authors.lastname: Hurley
authors.forename: N J
authors.initials: NJ
authors.lastname: Locher
mesh_terms: D000293:Adolescent; D002511:Cephalosporins / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology*; D005260:Female; D006801:Humans; D016268:Internal Fixators; D011183:Postoperative Complications / Q000382:microbiology*; D011292:Premedication; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion
chemical_list: D002511:Cephalosporins