Friday, December 11, 2009

Difficult

A patient presents to clinic with a skin and soft tissue infection. The provider gives empiric coverage with one agent, 300mg every six hours. The patient is reassured that this one drug will cover all usual skin and soft tissue bacteria. Unfortunately, she presents a week later complaining of severe watery diarrhea 10-15 times daily with lower abdominal cramping. She has a temperature of 38.5 and a WBC count of 16,000. Pathology would show the finding above.

Challenge: What's the diagnosis?

Image shown under fair use.

5 comments:

I. Kant said...

C Diff...

tree said...

contact isolation! wash your hands! no purell!

Suheil said...

Pseudomembranous colitis? Due to tetracycline?

Suheil said...

Caused by Clostridium Difficle

Craig Chen said...

A friendly reminder to wash hands!
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Difficult

Treatment of skin and soft tissue infections should empirically cover Streptococcus and Staphyloccocus, including MRSA. One agent that covers both is clindamycin. Unfortunately, clindamycin has an association with Clostridium difficile colitis, described here. The pathology shows multiple discrete white plaques of purulent exudate on the mucosal surface.

Sources: UpToDate; www.pathconsultddx.com (original image from Colour Atlas of Anatomical Pathology).