Ceftriaxone-Associated Colitis Detected by Tc (V)-DMSA: A Case Report

Received 10/17/2000; revised 11/29/2000; accepted 1/20/2001. For correspondence or reprints contact: Nan-Tsing Chiu, M.D., Department of Nuclear Medicine, National Cheng Kung University Hospital, 138, Sheng-Li Road, Tainan 704, Taiwan. Tel: (886)6-2766109, Fax: (886)6-2766609, E-mail: [email protected] A 61-year-old female presented with crampy abdominal pain and bloody diarrhea. She had been prescribed ceftriaxone sodium (0.5 gm twice a day) for soft tissue abscess over the right flank two days before the start of her symptoms. Abdominal examinations revealed diffuse tenderness in the abdomen with normal bowel sounds. Hb was 11.0 g/dl and white blood cell was 8470/mm. A Tc (V)-DMSA abdominal scan was performed with a gamma camera (Vertex, ADAC, USA) at 2 h following intravenous administration of 20 mCi (760 MBq) of Tc (V)-DMSA. Increased radioactivity in the transverse colon and descending colon was seen; there was no obvious abnormal radiotracer uptake over the right flank. Abdominal computed tomography (CT) showed increased soft tissue strands by the side of the splenic flexure and a thick parietal peritoneum by the side of the descending colon. A barium enema of the colon exhibited no stenotic lesion throughout the rectal and colonic loop and no abnormal fil l ing defect. Colonoscopy showed diffuse inflammatory change with swelling, hyperemia, and ulceration over the descending colon. Colonoscopy failed to reveal a pseudomembrane. A colonic biopsy revealed that the superficial mucosa was covered by fibrinopurlent exudate, cellular debris, and mucosa deposits. After withdrawal of antibiotics, fever subsided within 24 h and the bowel symptoms settled completely within 4 days. This case illustrates the utility of Tc (V)-DMSA for detecting active bowel disease in a debilitated patient with ceftriaxoneassociated colitis.