Persistent Clostridium Difficile Diarrhea, Thinking Beyond Pseudomembranous Colitis: A Case Report

The prevalence of Clostridium difficile infection (CDI) is increasing along with the availability of diagnostic tests and is becoming a common nosocomial infection. CDI is the cause of nearly all occurrences of pseudomembranous colitis as well as 10-25% of antibiotic-related diarrhea. In patients presenting with persistent C. difficile diarrhea, the most common cause is the recurrence of pseudomembranous colitis but other differential diagnoses may need to be considered. In this case, we report a case of C. difficile diarrhea associated with life-threatening colitis and bowel ischemia. We report the case of a 60-year-old male with persistent C. difficile diarrhea complicated by bowel ischemia. He presented with one month of persistent diarrhea and vomiting that had been worsening over the past three days; these symptoms were precipitated with prolonged antibiotic use. The patient was not known to have any chronic diseases but was attending the oncology outpatient clinic for an undiagnosed colonic mass that needed further examination. The patient’s vitals showed tachycardia (116 bpm), and a palpable left lumbar mass was noted on examination. The patient’s laboratory tests revealed significantly high inflammatory markers and deranged renal functions, and x-ray images showed hemicolitis. The patient was admitted because of dehydration. Computed tomography (CT) of the abdomen was conducted which revealed bowel ischemia. A high index of suspicion for bowel ischemia should be held in C. difficile cases presenting with persistent symptoms. C. difficile infection is a very common healthcare-associated infection, its risk factors are older age, hospitalizations, and severe diseases. There is a need to increase the awareness of clinicians and prompt the diagnosis if suspicion of complicated C. difficile is present such as bowel ischemia.