ABSTRACT
Pseudomembranous colitis (PMC) is known to be associated with antibiotic treatment, but is not commonly related to antitubercular (anti-TB) agent, rifampin. PMC is frequently localized to rectum and sigmoid colon, which can be diagnosed with sigmoidoscopy. We report a case of rifampin-induced PMC with rectosigmoid sparing in a pulmonary tuberculosis patient. An 81-year-old man using anti-TB agents was admitted with a 30-day history of severe diarrhea and general weakness. On colonoscopy, nonspecific findings such as mucosal edema and erosion were found in sigmoid colon, whereas multiple yellowish plaques were confined to cecal mucosa only. Biopsy specimen of the cecum was compatible with PMC. Metronidazole was started orally, and the anti-TB medications excluding rifampin were readministerred. His symptoms remarkably improved within a few days without recurrence. Awareness of rectosigmoid sparing PMC in patients who develop diarrhea during anti-TB treatment should encourage early total colonoscopy.
Subject(s)
Aged, 80 and over , Humans , Biopsy , Cecum , Colon, Sigmoid , Colonoscopy , Diarrhea , Edema , Enterocolitis, Pseudomembranous , Metronidazole , Mucous Membrane , Rectum , Recurrence , Rifampin , Sigmoidoscopy , Tuberculosis, PulmonaryABSTRACT
Pseudomembranous colitis is known to develop with long-term antibiotic administration, but antitubercular agents are rarely reported as a cause of this disease. We experienced a case of pseudomembranous colitis associated with rifampin. The patient was twice admitted to our hospital for the management of frequent bloody, mucoid, jelly-like diarrhea and lower abdominal pain that developed after antituberculosis therapy that included rifampin. Sigmoidoscopic appearance of the rectum and sigmoid colon and mucosal biopsy were compatible with pseudomembranous colitis. The antitubercular agents were discontinued and metronidazole was administered orally. The patient's symptoms were resolved within several days. The antituberculosis therapy was changed to isoniazid, ethambutol and pyrazinamide after a second bout of colitis. The patient had no further recurrence of diarrhea and abdominal pain. We report here on a case of pseudomembranous colitis associated with rifampin.
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Antibiotics, Antitubercular/adverse effects , Diarrhea/etiology , Enterocolitis, Pseudomembranous/chemically induced , Rifampin/adverse effects , Tuberculosis, Pulmonary/drug therapyABSTRACT
Objective To design and synthesize an antitubercular compound,24-ketoarguesterol.Methods The target compound was synthesized via 8 steps,including methyl esterification,grignard isopropylation,deportation,etc.,using hyodeoxycholic acid as the starting material.3?-tert-butyldimethylsilyoxyl-5?-hydroxyl-6?-di-me-thoxylmethyl-24-keto-B-norcholanate was the key intermediate and grignard isopropylation as the key step.Results The target compound was synthesized in a total yield of 42% and identified by mass spectrometry(MS),proton magnetic resonance spectroscopy(1HNMR),carbon magnetic resonance spectroscopy,(13CNMR)and infrared spectroscopy(IR).Conclusion The synthetic route is characterized by atomic economy and high efficiency and laid the foundation for development of novel antituberculous drugs.