{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:03:50Z","timestamp":1756425830307,"version":"3.44.0"},"reference-count":34,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>Pseudomembranous colitis and toxic megacolon (TM) are well-known complications of <jats:italic>Clostridium difficile<\/jats:italic> infections. Systemic antibiotic is considered as the major risk factor for the development of <jats:italic>C difficile<\/jats:italic> colitis. However, topical antibiotics are rarely associated with the infection. As previously thought, the use of topical antibiotic is capable of systemic absorption in damaged and denuded skin; sufficient enough to suppress the normal bowel flora. Here, we present an unusual case of TM from <jats:italic>C difficile<\/jats:italic> infection induced by topical silver sulphadiazine in a 60-year-old man with immune-bullous pemphigus vulgaris. The diagnosis is further complicated by the absence of diarrhoea as the initial presentation. Despite adequate medical and surgical intervention, the patient had an unfavourable outcome.<\/jats:p>","DOI":"10.1136\/bcr-2012-006460","type":"journal-article","created":{"date-parts":[[2012,8,9]],"date-time":"2012-08-09T09:08:04Z","timestamp":1344503284000},"page":"bcr2012006460","source":"Crossref","is-referenced-by-count":2,"title":["Toxic megacolon from fulminant <i>Clostridium difficile<\/i> infection induced by topical silver sulphadiazine"],"prefix":"10.1136","volume":"2012","author":[{"given":"Christopher B","family":"Tan","sequence":"first","affiliation":[{"name":"1Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dhyan","family":"Rajan","sequence":"additional","affiliation":[{"name":"2Department of Gastroenterology, Nassau University Medical Center, East Meadow, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitanshu","family":"Shah","sequence":"additional","affiliation":[{"name":"1Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shadab","family":"Ahmed","sequence":"additional","affiliation":[{"name":"3Department of Infectious Disease, Nassau University Medical Center, East Meadow, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lester","family":"Freedman","sequence":"additional","affiliation":[{"name":"4Department of Pathology, Nassau University Medical Center, East Meadow, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaleem","family":"Rizvon","sequence":"additional","affiliation":[{"name":"2Department of Gastroenterology, Nassau University Medical Center, East Meadow, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Mustacchia","sequence":"additional","affiliation":[{"name":"2Department of Gastroenterology, Nassau University Medical Center, East Meadow, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2012,8,9]]},"reference":[{"key":"2025082803155474000_2012.aug07_1.bcr2012006460.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(05)70215-2"},{"key":"2025082803155474000_2012.aug07_1.bcr2012006460.2","doi-asserted-by":"publisher","DOI":"10.1086\/511794"},{"key":"2025082803155474000_2012.aug07_1.bcr2012006460.3","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.6443"},{"key":"2025082803155474000_2012.aug07_1.bcr2012006460.4","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.142.7.624"},{"key":"2025082803155474000_2012.aug07_1.bcr2012006460.5","doi-asserted-by":"publisher","DOI":"10.1086\/338260"},{"key":"2025082803155474000_2012.aug07_1.bcr2012006460.6","doi-asserted-by":"publisher","DOI":"10.3109\/00365521.2011.605469"},{"key":"2025082803155474000_2012.aug07_1.bcr2012006460.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2003.07696.x"},{"key":"2025082803155474000_2012.aug07_1.bcr2012006460.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2007.11.017"},{"key":"2025082803155474000_2012.aug07_1.bcr2012006460.9","doi-asserted-by":"crossref","unstructured":"Arumilli BR Koneru P Fayyaz I . 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