PMC6328918_01
Time course and imaging findings of a 79-year-old man with fulminant pseudomembranous enterocolitis caused by Klebsiella oxytoca. A, Schema of the patient's clinical time course (min) from admission to death. ICU, intensive care unit; NAD (gamma), nor-adrenaline (mg/kg/min); PEA, pulseless electrical activity; sBP, systolic blood pressure. B,C, Contrast-enhanced computed tomography scan (6 h after admission). Arrows indicate intestinal dilatation and swelling, with the fluid level between the duodenum and the jejunum. However, there were no signs of ischemia or necrosis because the intestinal wall was well-enhanced with contrast media.
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Despite sufficient extracellular fluid, his blood pressure was not elevated and his abdomen gradually swelled (Fig. 1A). Contrast-enhanced computed tomography revealed intestinal dilatation but no sign of ischemia or necrosis (Fig. 1B,C).
Autopsy findings in a 79-year-old man with fulminant pseudomembranous enterocolitis caused by Klebsiella oxytoca. A, Images of intestinal necrosis in the autopsy. Mucosal necrosis is observed between the duodenum and jejunum (arrows). B, Intestinal necrosis is observed between the duodenum and jejunum. Arrows indicate pseudomembrane formation. C, Microscopic view. Hematoxylin-eosin staining (x40). D, High-power view (x100) of (C). Hematoxylin-eosin staining reveals mucosal hemorrhagic necrosis and submucosal edema in conjunction with pseudomembranous formation. E, Maximum-power view (x1,000) of (C). Arrows indicate gram-negative bacilli that correspond to K. oxytoca.
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Pseudomembrane formation was observed on the intestinal mucosa (Fig. 2B). The mucous membrane was completely destroyed and replaced with inflammatory cell filtration, submucosal edema, and cellular debris (Fig. 2C,D).