title: Toxic megacolon from fulminant Clostridium difficile infection induced by topical silver sulphadiazine.
abstract: Pseudomembranous colitis and toxic megacolon (TM) are well-known complications of Clostridium difficile infections. Systemic antibiotic is considered as the major risk factor for the development of C difficile colitis. However, topical antibiotics are rarely associated with the infection. As previously thought, the use of topical antibiotic is capable of systemic absorption in damaged and denuded skin; sufficient enough to suppress the normal bowel flora. Here, we present an unusual case of TM from C difficile infection induced by topical silver sulphadiazine in a 60-year-old man with immune-bullous pemphigus vulgaris. The diagnosis is further complicated by the absence of diarrhoea as the initial presentation. Despite adequate medical and surgical intervention, the patient had an unfavourable outcome.
authors.affiliation: Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA. ctan@numc.edu
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Tan
authors.forename: Dhyan
authors.initials: D
authors.lastname: Rajan
authors.forename: Mitanshu
authors.initials: M
authors.lastname: Shah
authors.forename: Shadab
authors.initials: S
authors.lastname: Ahmed
authors.forename: Lester
authors.initials: L
authors.lastname: Freedman
authors.forename: Kaleem
authors.initials: K
authors.lastname: Rizvon
authors.forename: Paul
authors.initials: P
authors.lastname: Mustacchia
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000009:adverse effects*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000209:etiology; D003082:Colectomy; D003937:Diagnosis, Differential; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis* / Q000209:etiology; D017809:Fatal Outcome; D006801:Humans; D007081:Ileostomy; D008297:Male; D008532:Megacolon, Toxic / Q000209:etiology* / Q000276:immunology / Q000382:microbiology; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D010391:Pemphigoid, Bullous / Q000188:drug therapy; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012307:Risk Factors; D012837:Silver Sulfadiazine / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000891:Anti-Infective Agents, Local; D012837:Silver Sulfadiazine