Histologic findings and clinical characteristics in acutely symptomatic ulcerative colitis patients with superimposed Clostridium difficile infection.

Objective: To examine biopsy specimens for histologic features suggestive of Clostridium difficile infection in patients with ulcerative colitis (UC).

Methods: Nine patients with UC had colonic biopsy specimens taken during a symptomatic flare that coincided with positive C difficile (C difficile+) tests. Twenty-eight controls were biopsied during a UC flare but tested negative for C difficile. We reviewed the slides for evidence of pseudomembranes, ischemic-like changes, degree of colitis, and lamina propria hemorrhage.

Results: In C difficile+ patients, 4 (44.4%) of 9 had microscopic pseudomembranes compared with 11% in controls (P < .05). Other histologic/clinical features were not predictive.

Conclusions: Although the presence of microscopic pseudomembranes suggests C difficile infection in patients with UC, sensitivity and specificity are poor; biopsy findings do not reliably detect this infection in patients with UC.