Expulsion of rope-like material per rectum in an infant: a rare case report of pseudomembranous colitis

Pseudomembranous colitis (PMC) is a severe manifestation of Clostridioides difficile infection and is exceedingly rare in early infancy. We report a unique case of a 2-month-old male infant who presented with fever, profuse watery diarrhea, vomiting, and the passage of multiple rope-like colonic mucosal casts in the stool, initially raising concern for intestinal parasitosis. Laboratory investigations revealed marked leukocytosis, severe hyponatremia, and elevated inflammatory markers. Abdominal ultrasonography revealed diffuse thickening of the colonic wall. Histopathological examination of the expelled material confirmed a complete cast of necrotic colonic mucosa consistent with severe colitis. Despite an initial negative toxin assay, subsequent polymerase chain reaction (PCR) testing detected C. difficile toxin genes (tcdA and tcdB). The patient responded well to aggressive supportive care and intravenous antimicrobial therapy. This case highlights a rare and misleading presentation of PMC in early infancy and underscores the critical role of histopathology in achieving an accurate diagnosis.