Acute renal failure in the onset of pseudomembranous colitis

Pseudomembranous colitis in recent years has become a fairly aggressive and widespread form of infection associated with the use of antibacterial therapy, refers to the most severe inflammatory bowel diseases, the cause of which is the grampositive sporeforming bacterium Clostridium difficile. The main symptoms of pseudomembranous colitis include: frequent watery loose stools, fever (up to 3-40 °C), abdominal pain. This article presents a clinical observation of a patient with pseudomembranous colitis, the peculiarity of which is that the patient had no stool disorder and no abdominal pain against the background of prolonged subfebrility (1.5 months). The debut of the disease began with a collapse, a convulsive attack, the phenomena of acute kidney damage, which did not allow for a timely correct diagnosis. Women received inpatient care, examined by many specialists, including a urologist, an infectious disease doctor, received therapy with linezolid (400 mg × 2 times a day – 10 days), bakperazone (1 g × 2 times a day), meropenem 1000 mg × 3 times a day with a working diagnosis of «Acute pyelonephritis. Acute kidney injury in the resolution stage». Untimely diagnosis of the disease can lead to life-threatening complications: intestinal translocation syndrome, severe sepsis, multiple organ dysfunction syndrome. The above, dictates the need to inform doctors of the practical level of healthcare about the problem of pseudomembranous colitis, since it is known that with timely diagnosis of pseudomembranous colitis K and adequate anticlostridiosis therapy, it is possible to save the patient's life. It is necessary to inform doctors more widely about the possibility of an atypical course of the disease and to increase the alertness of doctors regarding the disease caused by pseudomembranous colitis, Clostridium difficile, antibacterial pneumonia, acute kidney injury.

1. Shelygin Yu. A., Alyoshkin V. A., Suhina M. A. i dr. Clinical recommendations of the National Association of Specialists in the control of infections related to the provision of medical care and the All-Russian public non-profit organization «Association of Coloproctologists of Russia» on the diagnosis, treatment and prevention of Colostridium difficileassociated diarrhea (CDI) // Koloproktologiya. 2018; (3): 7-23. (In Russ.) https://doi.org/10.33878/2073-7556-2018-0-3-7-23.

2. Nechaeva Yu. Review of sales of antibacterial drugs for the first 9 months of 2020 // Remedium. 2020; (10): 18-21. (In Russ.)

3. Ivashkin V. T., Shifrin O. S., Tertychnyj A. S. Clostridium difficile-associated disease // Roscijskij zhurnal gastroenterologii, gepatologii, koloproktologii. 2015; (6): 5-17. (In Russ.)

4. Ivashkin V. T., Yushchuk N. D., Maev I. V. i dr. Recommendations of the Russian Gastroenterological Association for the diagnosis and treatment of Clostridium difficile-associated disease // Rossijskij zhurnal gastroenterologii, gepatologii, koloproktologii. 2016; (5): 56-65. (In Russ.)

5. Malov V. A., Bondarenko V. M., Pak S. G. The role of Clostridium difficile in human pathology // Zhurnal mikrobiologii. 1996; (1): 91. (In Russ.)

6. Hensgens M. P., Goorhuis A., Dekkers O. M., et al. Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics // J Antimicrob Chemother. 2012; (3): 742-748.

7. Demin A. A., Rudnov V. A. Colitis associated with Clostridium difficile after colon cancer surgery // Infekcii v hirurgii. 2007; 5 (2): 29-33. (In Russ.)

8. Van Ness M. M., Cattau Jr. Fulminant colitis complicating antibiotic associated pseudomembranous colitis: case report and review of the clinical manifestations and treatment // Am. J. Gastroenterol. 1987; 82 (4): 374-377.

9. Malov V. A., Pak S. G., Belikov D. V. Pseudomembranous colitis // Lechaschi Vrach. 1999; (2-3): 4-9. (In Russ.)

10. Ho N. Lacking the incentive to cure? Recurring Clostridium difficile diarrhea and our reluctance to use fecal transplantation // J. Clin. Gastroenterol. 2011; 45 (4): 379-380.

11. Silverman M. S., Davis I., Pillai D. R. Success of self-administered home fecal transplantation for chronic Clostridium difficile infection // Clin. Gastroenterol. Hepatol. 2010; 8 (5): 471-473.

12. McCollum D. L., Rodriguez M. J. Diagnosis, treatment and prevention of infection caused by Clostridium difficile // Clinicheskaya gastroenterologiya i gepatologiya. 2012; 5 (4): 169-182.