Dr. Cowan is a Staff Hospitalist at George E. Wahlen VAMC. Dr. Kutty is a Gastroenterology Fellow at the University of Utah School of Medicine, and Dr. Cowan is an Assistant Professor at the University of Utah Hospital Department of Internal Medicine, both in Salt Lake City. Correspondence: Dr. Cowan (amy.cowan@va.gov)
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
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Conclusion
Typical clinical manifestations of fulminant colitis include fever, diarrhea, abdominal pain, distention, and frequently WBC counts > 20,000 cells/μL. However, C difficile colitis, also known as pseudomembranous colitis, occasionally can present as an acute ileus, with little or no diarrhea.1 This veteran had several risk factors for C difficile infection, which included long-term residence in an extended care facility, frequent asthma exacerbations that required antibiotics, severe chronic disease, aged > 65 years,and ciprofloxacin given the first 3 days of this hospitalization.2 Until the endoscopy results were presented, no one on the patient’s care team, including gastroenterology and infectious disease, had included an infectious etiology in the differential diagnosis. This case reinforces the need to broaden differential diagnoses and look beyond assumptions that opioids without an adequate bowel regime were the cause. Avoiding anchoring heuristics can be a challenge as this case demonstrates.
