Clostridium difficileColitis: A Possible Cause of Unexplained Elevation of Serum Alkaline Phosphatase Levels in Patients with AIDS

and the 5؅NT level was 17 IU/L (normal, õ 10 IU/L). A repeated C. difficile toxin assay was positive at a titer of 1:100. Treatment Most elevations in serum levels of alkaline phosphatase (AP) with vancomycin (125 mg po q.i.d.) was initiated and gradually in patients with AIDS result from hepatobiliary disorders, but un-tapered over 2 months. The patient remained afebrile, and the AP explained elevations are also encountered [1, 2]. We describe level declined to 136 U/L. After completion of therapy and at a marked elevations in serum levels of AP secondary to Clostridium 6-month follow-up evaluation, the serum levels of AP and GGTP difficile colitis in a patient with AIDS. remained normal. The chronic diarrhea subsequently resolved fol-A 58-year-old male with AIDS presented to the hospital with a fever (temperature, 103ЊF). His medical history was notable for chronic diarrhea secondary to duodenal microsporidiosis, which was treated unsuccessfully with metronidazole. Findings on physical examination were unrevealing. The WBC count was 5,600/mL, and the AP level was 1,100 U/L. Levels of transaminases, bilirubin, albumin, g-glutamyl transpeptidase (GGTP), and 5؅ nucleotidase (5؅NT) were normal, as was the prothrombin time. Radiological studies, including a bone scan, did not show any abnormalities, and multiple blood cultures were negative. The patient's temperature normalized over 48 hours, and he was discharged. Five days later, he was readmitted with fever, chills, and vomiting ; the chronic diarrhea persisted. Physical examination revealed a temperature of 99.6ЊF, a normal abdomen, and blood in his stools. The WBC count was 4,200/mL with 34% neutrophils and 47% band forms. The AP level was 1,850 U/L; levels of liver transaminases remained normal. Plain abdominal films showed a dilated colon with thumbprinting; an ultrasonogram revealed a normal liver and biliary tree with moderate ascites; an abdominal CT scan showed colitis, pneumatosis, and ascites (figure 1). Sig-moidoscopy demonstrated the presence of yellow plaques; pseudo-membranous colitis was confirmed by examination of biopsy specimens and by the results of a C. difficile toxin assay (titer, 1:1,000). The fever cleared with metronidazole therapy, the AP level decreased to 611 U/L, and repeated abdominal CT scan showed regression of the colonic inflammation previously evident and resolution of the ascites. The patient received metronidazole for 14 days, and 1 week after the drug was discontinued, his fever recurred (temperature, 102ЊF). The chronic diarrhea was still present and unchanged in nature. The WBC count was 3,800/mL with 34% band …