Infant Male With Blood-Colored Stools

[Ann Emerg Med. 2009;54:308.]

A 10-month-old boy presented to a pediatric emergency department with a 1-day history of blood-colored stools. The patient had no history of abdominal pain, fever, vomiting, or diarrhea. Four days before, he had been prescribed cefdinir, a third-generation oral cephalosporin, for a pharyngeal abscess. On examination, he was playful and his vital signs were normal. He had blood-red stool in his diaper (Figure), which was guiac negative. His diet included iron-fortified formula, but he had no supplements.

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Figure. Diaper with red-colored stool. Used with permission of Martina Mookadam, MD, MS, Department of Family Medicine, Mayo Clinic, Scottsdale, AZ.

Diagnosis 

Cefdinir-associated red stool 

Without further evaluation, he was discharged home to complete his course of antibiotics. His final diagnosis was cefdinir-associated red stools, which is a benign process caused by the formation of a cefdinir-iron complex.1 The incidence of red stools is unknown, but may be as high as 10%.2 It has, however, led to parental and physican distress and to extensive testing and hospitalizations for what is simply a benign drug adverse effect.1, 3, 4