Abstract
Background and Objectives: Gut microbiota plays an important role in the wellbeing of the host through different interactions between microflora constituents. In certain instances, Clostridioides difficile may pullulate, causing infection with associated colitis that may vary in terms of severity from mild disease to severe colitis, with increased associated mortality due to its complications. However, there are few literature data regarding the association between Clostridioides difficile and ischemic colitis. Case report: We report the case of a 30-year-old male patient, overweight, with impending dehydration, who presented with hematochezia and colicky abdominal pain, with positive fecal tests for the detection of Clostridioides difficile infection and endoscopic appearance suggesting ischemic colitis in the sigmoid and left colon, confirmed by computed tomography and histology. The patient was treated with oral Vancomycin, with resolution of symptoms, and was reevaluated through colonoscopy eight weeks after discharge, with endoscopic mucosal normalization and histological scarring process on biopsy samples. Conclusion: We report one of the few cases in the literature of ischemic colitis associated with Clostridioides difficile infection, with resolution of clinical, endoscopic, and histologic changes after specific treatment with oral Vancomycin suggesting a possible association between the two diseases. We also review the existing literature data regarding this comorbid association.
Highlights
There is growing evidence supporting the interaction between the host and gut microbiota which further promotes wellbeing and health
The disease may develop due to multiple factors, including but not limited to different drugs usage, especially antibiotics and proton-pump inhibitors (PPIs), which interfere with intestinal flora promoting colonization and altering the immune status in prone patients with inadequate nutritional status [6]
The inflammation secondary to Clostridioides difficile infection (CDI) colitis in the setting of impending dehydration could have precipitated local ischemia. Another theory resides on an initial ischemic colonic injury causing diarrhea associated with CDI through a mechanism based on dysbiosis, similar to the mechanism seen in patients suffering from ulcerative colitis [33]
Summary
There is growing evidence supporting the interaction between the host and gut microbiota which further promotes wellbeing and health. The main implications of microflora in the host–gut interaction resides in the process of short-chain fatty acids production through breaking down of indigestible dietary proteins and carbohydrates Another major role of microbiota consists of vitamin production, ions absorption, and conversion of alimentary polyphenols into their active forms. The disease may develop due to multiple factors, including but not limited to different drugs usage, especially antibiotics and proton-pump inhibitors (PPIs), which interfere with intestinal flora promoting colonization and altering the immune status in prone patients with inadequate nutritional status [6]. Common risk factors associated with the development of CDI include prior hospitalization, advanced age, obesity, the use of medication such as antibiotics, proton-pump inhibitors and non-steroidal anti-inflammatory drugs [7,8,9,10]. We present a case where IC and CDI were diagnosed concurrently, in a patient with apparently no risk factor for any of the two diseases
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