Going Beyond Colon-Clostridium difficile Enteritis: A Rare but Real Entity!

Abstract

Purpose:Clostridium difficile infection (CDI), a common cause of health care-associated diarrhea, is usually considered being restricted to colon. We present a rare case of isolated CDI of small bowel in a young patient without any major risk factors. Results: A 22-year-old female presented to the emergency department (ED) with complaints of worsening abdominal pain, nausea, and vomiting for 3 days. Patient denied fever, chills, hematemesis, hematochezia, melena, sick contact, recent antibiotic use, or recent hospitalization. She had never been diagnosed with inflammatory bowel disease nor had family history of the disease. Abdominal examination was remarkable for hypoactive bowel sounds and peri-umblical tenderness. CT scan of the abdomen showed ileus with small bowel wall thickening concerning for enteritis. Laboratory investigations were notable for white blood cell count of 14.3K/mm3 with 85% granulocytes and C-Reactive Protein (CRP) >380mg/L and serum creatinine of 0.5mg/dl. Stool Clostridium difficile toxin PCR was positive, and fecal WBC were negative. Patient was started on IV metronidazole 500 mg TID with improvement of symptoms and normalization of CRP in 1 week period. Patient was able to tolerate diet. A repeat abdominal CT scan showed interval improvement of small bowel thickening. Patient remained stable and was discharged home. A follow-up colonoscopy in 4 weeks did not show any evidence of IBD. Repeat abdominal CT scan showed complete resolution of bowel wall thickening. Patient remained symptom free on follow-up appointment. Conclusion:Clostridium difficile is considered to be a colonic pathogen. Untreated cases are associated with significant morbidity and mortality. C. difficile enteritis is a rare entity and is usually associated with immune compromised states, old age, and surgically altered intestinal anatomies. The fact that this is a relatively young patient with no predisposing medical illnesses and risk factors makes it a unique case. Reporting such cases will help recognize and provide future clinical insight into community acquired C.difficile enteritis. Clinical recognition of C. difficile infection not only in colon but also in small intestine can improve clinical outcomes in patients.