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

Eosinophilic enteritis is an uncommon disease of unknown cause characterized by eosinophilic infiltration in various areas of the gastrointestinal tract with symptoms. It is generally classified according to the layer of the gastrointestinal tract involved. Eosinophilic infiltration of the serosa is the rarest form of presentation and may manifest eosinophilic ascites. We report a case of a 47-year-old man who experienced progressing abdominal pain. A diffuse erythematous change of the gastric mucosa was observed on gastrofibroscopy. An abdominal computed tomography and colonoscopy showed diffuse wall thickening of the small bowel and colon with a small amount of ascites. Eosinophilic infiltration was confirmed by multiple biopsies of the gastrointestinal tract and peritoneal fluid analysis. The patient was treated with corticosteroid and responded dramatically.

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.

With increase of endoscopy, physical trauma including endoscopic procedure can develop gastric submucosal hematoma. Symptoms are usually abdominal pain, vomiting, fever and bloody stool due to upper GI tract obstruction and complications like intestinal obstruction or peritonitis. Diagnosis is usually made by CT, trans-esophageal sonogram and patients with no intestinal obstruction or peritonitis complications and good general condition usually recover with only conservative treatment. Authors have experienced submucosal hematoma developed after submucosal epinephrine injection with intent to uplift distal lesion in gastric polypectomy and improved with conservative treatment.