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CC BY-NC-ND 4.0 · Journal of Gastrointestinal Infections 2025; 15(01/02): 46-50
DOI: 10.1055/s-0045-1811609
Case Report

Severe Pseudomembranous Colitis Following Distal Femur Plating: A Case for Early Endoscopic Evaluation Despite Negative Clostridioides difficile Testing

Authors

  • Aparna Jayara 

    1   Department of Critical Care Medicine, Breach Candy Hospital Trust, Mumbai, Maharashtra, India

  • Bhupinder Singh

    1   Department of Critical Care Medicine, Breach Candy Hospital Trust, Mumbai, Maharashtra, India

  • Pankaj Dhawan

    2   Department of Gastroenterology, Breach Candy Hospital Trust, Mumbai, Maharashtra, India

Funding No funding was received for the preparation or publication of this case report.
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Abstract

Pseudomembranous colitis is a serious complication typically linked to Clostridioides difficile following antibiotic use. Even when standard diagnostic tests are negative, persistent symptoms should warrant early endoscopic evaluation. This case highlights the diagnostic and therapeutic approach in an elderly postoperative patient.

An 88-year-old female underwent distal femur plating surgery complicated by postoperative septic shock, which was treated by broad-spectrum antibiotics. Subsequently, she developed high-volume diarrhea, abdominal pain, and leukocytosis. Initial C. difficile polymerase chain reaction testing was negative. Owing to unresolved gastrointestinal symptoms and strong clinical suspicion, colonoscopy was performed, revealing extensive pseudomembranous colitis. The patient received targeted antibiotic therapy and supportive care. Her symptoms resolved fully, and follow-up endoscopy confirmed mucosal healing. This case underscores the limitations of polymerase chain reaction for C. difficile, particularly in the context of strong clinical suspicion. Early endoscopic assessment should be considered in patients with persistent diarrhea despite negative laboratory findings. Moreover, this illustrates the critical role of antibiotic stewardship in preventing severe colitis.

Keywords

colitis - Clostridioides difficile - endoscopy - polymerase chain reaction - diarrhea - antibiotic-associated

Ethical Statement

Written informed consent was obtained from the patient for the publication of this case report and any accompanying images.


Authors' Contributions

A.J. drafted the initial manuscript and conducted the literature review; B.S. contributed to the manuscript revision; and P.D. performed the endoscopy and help with clinical images.




Publication History

Received: 12 March 2025

Accepted: 07 August 2025

Article published online:
09 October 2025

© 2025. Gastrointestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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