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A 75-year-old woman with severe mixed connective tissue disorder and hyperten- sion presented with worsening diarrhea, nausea and vomiting. On admission she complained of 10 - 12 episodes of watery diarrhea which also occurred at night. The patient had suffered from diarrhea for 2 months, and during these last 2 months she had received antibiotic ther- apy twice, first to treat a pneumonia and then to treat a urinary tract infection. When she first developed diarrhea it was assumed that it was antibiotic-associated and she was given empiric therapy for Clostridium difficile infection. Her diar- rhea had improved slightly , but the stool had remained soft until a week prior to the present admission, when worsening watery diarrhea had begun again. The bowel movements were associated with tenesmus but without passage of blood or mucus. The patient was taking the fol- lowing medications: oral corticosteroids, CellCept, amlodipine, metoprolol, torase- mid, and potassium chloride. She was ad- mitted with clinical and laboratory evi- dence of dehydration. Physical examina- tion was notable for a low-grade fever (37.9 8C). The abdomen was tympanitic, with normal bowel sounds, tenderness to palpation in both lower quadrants, but no rebound pain. Digital rectal examination revealed liquid yellow, guaiac-positive stool. Laboratory values (normal values in parentheses) on admission were nota- ble for white blood cell count of 1 2 800/ ml (4.300 - 10.000/ml), hemoglobin 6.5 g/ dl (12.0 - 16.0), albumin 2.3 g/dl (3.5 - 5.5), creatinine 208 mol/ml (< 1 20), and C-reactive protein of 230.2 (< 5). Stool studies for ova and parasites, culture and sensitivity, fecal leukocytes, and C. difficile to xin were obtained. Stool tests for C. dif- ficile toxin were negative on three occa- sions. Colonoscopy revealed multiple

Pseudomembranous colitis due to Salmonella enterica serotype infantis