Ewha Med J.  2013 Dec;36(Suppl):S5-S8. 10.12771/emj.2013.36.S.S5.

Clostridium difficile Colitis after Topical Ophthalmic Use of Levofloxacin

• Lee JW
• Woo SY
• Park SJ
• Hong SH
• Lee SY
• Woo SM

• KMID: 1726726
• DOI: http://doi.org/10.12771/emj.2013.36.S.S5

Abstract

Clostridium difficile colitis (CDC) has been associated with virtually all available antibiotics. It is well known that administration of drugs by the ocular route can result in systemic absorption with the possibility of systemic effect. We report a case of a 74-year-old woman who was treated with 0.5% levofloxacin eyedrops for ten weeks running for the post operative management of two separate bilateral cataract surgeries. Toxin assay for C. difficile was positive and the endoscopic findings were compatible with CDC. The plasma concentrations reached after intraocular administration of levofloxacin seem so trivial, but the administration of topical agents could make accumulated effect and be a potential cause of systemic toxicity.

Keyword

Clostridium difficile; Enterocolitis; Levofloxacin; Ophthalmic solutions

MeSH Terms

Absorption
Aged
Anti-Bacterial Agents
Cataract
Centers for Disease Control and Prevention (U.S.)
Clostridium difficile*
Clostridium*
Colitis*
Enterocolitis
Female
Humans
Levofloxacin*
Ophthalmic Solutions
Plasma
Running
Anti-Bacterial Agents
Ophthalmic Solutions

Figure

• 

  Fig. 1 Abdominal computed tomography findings. They show diffuse edematous wall thickenings (white arrows) of the entire colon (A, B).

• 

  Fig. 2 Sigmoidoscopic finding. It shows multiple yellowish plaques with erythematous and edematous mucosa in the sigmoid colon.

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  Fig. 3 Pathologic finding of biopsy specimen from colon mucosa. It shows severe erosion with pseudomembrane composed of fibrinous neutrophilic exudates (white circle) (H&E, ×100).

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  Fig. 4 Follow-up endoscopic finding. It shows a nearly improved state of colitis with no pseudomembrane.

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