Clostridium difficile colitis (CDC) has been associated with virtually all available antibiotics. It is well known that administration of drugs by the ocular route can result in systemic absorption with the possibility of systemic effect. We report a case of a 74-year-old woman who was treated with 0.5% levofloxacin eyedrops for ten weeks running for the post operative management of two separate bilateral cataract surgeries. Toxin assay for C. difficile was positive and the endoscopic findings were compatible with CDC. The plasma concentrations reached after intraocular administration of levofloxacin seem so trivial, but the administration of topical agents could make accumulated effect and be a potential cause of systemic toxicity.

Citations

Citations to this article as recorded by  

• Concurrent Use of Sulfonylureas and Antimicrobials of the Elderly in Korea: A Potential Risk of Hypoglycemia
  Sera Lee, Miyoung Ock, Hyunah Kim
  Korean Journal of Clinical Pharmacy.2018; 28(3): 188.     CrossRef
• Levofloxacin
  
  Reactions Weekly.2014; 1490(1): 25.     CrossRef

Hyperlipidemia can be a cause of acute pancreatitis. For example, dyslipidemia classified Fredrickson/WHO classification type I, V can induce acute pancreatitis spontaneously. Secondary hyperlipidemia (DM, alcohol, estrogen, etc.) also can induce acute pancreatitis. High serum amylase level and triglyceride level are hall markers of diagnosis. But lactescent serum interferes with accurate laboratory analysis of amylase. Serum amylase was normal or low in 50% of cases. Clinical course and treatment are similar with other causes of acute pancreatitis. Lipoprotein electrophoresis helps classify dyslipidemia by Fredrickson/WHO classification. In some cases, to prevent hyperlipidemic pancreatitis, serum triglyceride should be lower than 500 mg/dl. We report two cases of acute pancreatitis caused by dyslipidemia.

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