title: Development of pseudomembranous colitis four months after initiation of rifampicin.
abstract: Pseudomembranous colitis (PMC) may develop with long-term antibiotic administration, but is rarely reported to be caused by antitubercular agents. We present a case of PMC that occurred 120 days after starting rifampicin. A 74-year-old man was diagnosed with pulmonary tuberculosis and started on a standard HERZ regimen (isoniazid, ethambutol, rifampicin, pyrazinamide). After 4 months of HERZ, he presented with frequent bloody, mucoid, jelly-like diarrhea and lower abdominal pain. Sigmoidoscopy revealed multiple whitish plaques with edematous mucosa that were compatible with PMC. Biopsies from these lesions showed ulcer-related necrotic and granulation tissue. We stopped antitubercular treatment and started the patient on oral metronidazole. His symptoms completely resolved within 2 weeks. Antitubercular treatment was restarted by replacing rifampicin with levofloxacin. The patient did not present with diarrhea or bloody stool throughout the rest of treatment.
authors.affiliation: Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Jeong Moon
authors.initials: JM
authors.lastname: Choi
authors.forename: Hyung Hun
authors.initials: HH
authors.lastname: Kim
authors.forename: Seun Ja
authors.initials: SJ
authors.lastname: Park
authors.forename: Moo In
authors.initials: MI
authors.lastname: Park
authors.forename: Won
authors.initials: W
authors.lastname: Moon