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

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• 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

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.