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Pseudomembranous colitis is a life-threatening complication of broad spectrum antibiotic therapy caused by Clostridium difficile. Untreated, the disease can lead to severe and in many cases fatal complications such as peritonitis due to colonic wall perforation, shock as a consequence of volume depletion, toxic megacolon and massive lower gastrointestinal haemorrhage. Fatal complications mostly occur in elderly people with a high degree of comorbidity. We report the case of a 43-year-old patient with AIDS who was admitted to hospital with abdominal pain of unknown origin and died before the correct diagnosis could be established. Autopsy and postmortem stool cultures revealed severe pseudomembranous colitis due to C. difficile with toxic cardiac and circulatory failure as cause of death. [ABSTRACT FROM AUTHOR]