A Case of Clostridium difficile Colitis Induced by Rifampicin

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Abstract
Pseudomembranous colitis (PMC) induced by antibiotics, especially clinidamycin or lincomycin, has been well known by clinicians as a common side effect among the patients who were on the drugs. The isolation of Clostridium difficile from faeces and the detection of cytopathic toxin of C. difficile have been the prevailing methods in determining the etiological mechanism of antibiotics-associated PMC. The first case of PMC induced by rifampicin (RFP) was reported in 1980. Only seven cases were described afterwards in the western hemisphere. On the other hand, no case of PMC definitely associated with RFP has been reported, as far as we know, in Japan. An eighty two year old woman developed colitis 13th day after commencing antituberculous agents, RFP (0.45g/day), ethanbutol (1.0g/day) and isoniazide (0.4g/day). Colonoscopy showed the presence of pseudomembrane-like mucosal change, although it was not confirmed by histopathology. C. difficile resistant to RFP (1.8×109 colony forming units 1g wet weight faeces) was isolated from faeces and cytopathic toxin was detected in the supernatant of the faeces. After being diagnosed asC.difficile colitis, withdrawal of antituberculous agents and administration of metronidazole (0.75g/day) led to rapid recovery.

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