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Severe Antibiotic-Associated Colitis in a Patient With Cystic Fibrosis and Colonic Wall Thickening

Eighty-five to ninety percent of patients with cystic fibrosis (CF) have gastrointestinal complications. The differential diagnosis includes distal intestinal obstruction syndrome, Crohn disease, fibrosing colonopathy, and colonic disease, an entity that Pickhardt et al. (1) described as proximal colonic wall thickening with abdominal pain. Recently Clostridium difficile infections with atypical presentation have been added to this list (2). C. difficile is the primary cause of most cases of pseudomembranous colitis and of many cases of antibioticassociated colitis (AAC). Carriage rates of C. difficile in patients with CF are high (32%–50%) (3,4) when compared with the normal adult population (2%). Classic symptoms of AAC are rare in patients with CF, whereas patients with atypical presentations (constipation and stool impaction) are often underdiagnosed, or the correct diagnosis is missed and appropriate treatment is delayed. Because the disease can cause quick deterioration, knowledge of the atypical symptoms of AAC should be familiar to physicians treating patients with CF. We report an atypical case of AAC caused by C. difficile in a 28-year-old patient with CF and underlying colonic wall thickening.