Figure 5.

Acute toxic megacolon in a patient with fulminant pseudomembranous colitis. Note the thickened and edematous bowel wall (arrow). Such patients have abdominal pain, fever, leukocytosis, and hypoalbuminemia, but they may not have diarrhea. Many clinicians would suspect ischemic colitis, rather than Clostridium difficile colitis. This form of C. difficile disease has a very high mortality rate and a poor response to vancomycin and metronidazole. In addition to the usual therapy in such patients, physicians might want to consider early use of passive immunotherapy against C. difficile toxins, as described in reference 14 and in several of the treatment references listed at the end of this article. Reprinted from reference 10 with permission from the American Medical Association.