title: Fatal fulminant Clostridium difficile colitis during CHOP therapy for lymphoma: an autopsy case.
abstract: Although Clostridium difficile colitis is a common problem during chemotherapy, fulminant expression is rarely observed. Here, we describe a 68-year-old woman who developed fatal colitis due to Clostridium difficile infection. The patient was treated with CHOP therapy for relapsed lymphoma. In the nadir phase, she developed severe bloody diarrhea with a high fever and died within 12 hours after the beginning of symptoms. Clostridium difficile was identified in her stool and an autopsy showed hemorrhagic necrosis on the whole colon and rectum. This case demonstrates the substantial incidence of an unexpected feature with Clostridium difficile infection even with popular chemotherapy.
authors.affiliation: Division of Hematology-Oncology, Chiba Cancer Center, Chiba, Japan. htsujimu@chiba-cc.jp <htsujimu@chiba-cc.jp>
authors.forename: Hideki
authors.initials: H
authors.lastname: Tsujimura
authors.forename: Chikara
authors.initials: C
authors.lastname: Sakai
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ishii
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Takagi
authors.forename: Kyoya
authors.initials: K
authors.lastname: Kumagai
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001344:Autopsy; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003520:Cyclophosphamide / Q000009:adverse effects; D018450:Disease Progression; D004317:Doxorubicin / Q000009:adverse effects; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology* / Q000503:physiopathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016393:Lymphoma, B-Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D011239:Prednisolone / Q000009:adverse effects; D018570:Risk Assessment; D012720:Severity of Illness Index; D014750:Vincristine / Q000009:adverse effects
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone