溃疡性结肠炎(UC)是一种慢性、终身炎症性肠病,通常表现为血性腹泻,发烧,腹痛,和白细胞增多。诊断通常基于临床表现,内镜活检,并排除替代诊断。在非常罕见的情况下,在早期UC发作患者的结肠镜检查中可能发现假膜。历史上,假膜的客观发现仅用于诊断艰难梭菌感染(CDI);然而,必须正确使用诊断测试来确认CDI是否真正是假膜存在的原因,而不是替代病因,比如UC。在这种情况下,我们讨论了一名43岁的女性,她在门诊就诊的可疑CDI后,因慢性血性腹泻恶化而到医院就诊.她接受了内镜检查,显示假膜性结肠炎;然而,艰难梭菌测试显示一个阳性胃肠(GI)病原体组和多个阴性抗原和毒素酶免疫测定(EIA)。临床怀疑早期UC,患者接受了美沙拉嗪灌肠治疗,出院前临床好转。几个月后,她接受了内镜活检评估,结果与UC的诊断一致。
Ulcerative colitis (UC) is a chronic, life-long inflammatory bowel disease that normally presents with bloody diarrhea, fever, abdominal pain, and leukocytosis. Diagnosis is usually based on clinical presentation, endoscopy with biopsy, and exclusion of alternative diagnoses. In very rare cases, pseudomembranes may be found on colonoscopy in patients with an early UC flare. Historically, the objective finding of pseudomembranes has been exclusively used to diagnose a Clostridioides difficile infection (CDI); however, diagnostic testing must be correctly utilized to confirm whether a CDI is truly the cause of the presence of pseudomembranes, and not an alternative etiology, such as UC. In this case, we discuss a 43-year-old female who presented to the hospital with worsening chronic bloody diarrhea after being seen in the outpatient clinic for a questionable CDI. She underwent endoscopic evaluation revealing pseudomembranous colitis; however, C. difficile testing showed one positive gastrointestinal (GI) pathogen panel and multiple negative antigens and toxin enzyme immunoassays (EIA). With a clinical suspicion of early UC, the patient was treated with mesalamine enemas and improved clinically before discharge. Several months later, she underwent endoscopic evaluation with biopsy, which showed findings consistent with a diagnosis of UC.