Toxic megacolon from fulminant Clostridium difficile infection induced by topical silver sulphadiazine

Abstract

Pseudomembranous colitis and toxic megacolon (TM) are well-known complications of Clostridium dif ficile infections. Systemic antibiotic is considered as the major risk factor for the development of C difficile colitis. However, topical antibiotics are rarely associated with the infection. As previously thought, the use of topical antibiotic is capable of systemic absorption in damaged and denuded skin; sufficient enough to suppress the normal bowel flora. Here, we present an unusual case of TM from C difficile infection induced by topical silver sulphadiazine in a 60-year-old man with immune-bullous pemphigus vulgaris. The diagnosis is further complicated by the absence of diarrhoea as the initial presentation. Despite adequate medical and surgical intervention, the patient had an unfavourable outcome. Copyright 2012 BMJ Publishing Group. All rights reserved.