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
