Issn Print: 0277-2116

Publication Date: 2001/09/01


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Clinical Quiz

Joseph Fitzgerald; Riccardo Troncone; Conrad R. Cole; Ajay Kaul

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Excerpt

A 19-month-old female infant came to the emergency room with a 5-day history of intermittent abdominal pain and diarrhea. She has been passing 8 to 10 brown, watery stools a day. There was no blood or mucus in her stools. She had vomited twice (once at the onset of the illness and on the day of presentation), and the vomitus was nonbloody and nonbilious. She had no fever or other systemic symptoms. There was no prior antibiotic use. Her mother had diarrhea for 2 days at the onset of her illness.
Physical examination results were within normal limits except for right lower quadrant tenderness. No masses were palpated. Rectal examination results were normal, but her stool was guaiac positive.
Laboratory study results included a hemoglobin concentration of 11.9 g/dL and a leukocytosis of 17,400/mm 3 with a normal white blood cell differential count. Renal profile and urinalysis results were normal. Her stool was negative for leukocytes but positive for Clostridium difficile toxin and antigen. Abdominal radiographs were obtained (Fig. 1), and when she continued to have significant abdominal pain, an abdominal computed tomography was requested (Fig. 2).
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