Emerging evidence suggests fecal microbiota transplant (FMT) is safe and effective in immunocompromised patients for the treatment of C. difficile infection (CDI), however, it is not recommended for patients with severe neutropenia. Ongoing clinical trials using FMT in bone marrow transplant (BMT) recipients postpone FMT until neutrophil count normalizes. A 56 year old man post BMT on chemotherapy (day 4) for relapsing myeloma presented with diarrhea, fever (T= 101.6 F), and hypotension. His labs revealed an absolute neutrophil count (ANC) of 1,000/mm3, creatinine 0.8 mg/dL, albumin 2.2 g/dL, and lactate 4.4 mmol/L. Abdominal CT showed pancolitis without megacolon. He was diagnosed with fulminant CDI (by stool PCR) and started on oral vancomycin and intravenous metronidazole. His fever defervesced but diarrhea continued. On hospital day 3, he developed severe abdominal pain with ileus. CT findings were consistent with toxic megacolon with transverse colon measuring 9 cm in diameter. ANC dropped to a nadir of 10/mm3. He was not deemed a surgical candidate. Following a detailed discussion of procedural risks, infectious complication and lack of experience with FMT in severe neutropenia, FMT via colonoscopy was pursued. Pseudomembranes were noted. Oral vancomycin was reinitiated post-FMT and sequential FMTs were performed every 2-3 days according to our previously published protocol. While there was clinical improvement after each FMT, he relapsed after 24-48 hours. A total of 9 FMTs, using frozen stool bank material from a universal donor, were administered (5 via colonoscopy and 4 via nasoduodenal tube) over 19 days at which time he was amenable to discharge on oral vancomycin for 14 days. After completion of the outpatient vancomycin course, his diarrhea and abdominal pain returned and stool C. difficile was positive by PCR. Repeat inpatient colonoscopic FMT was performed and pseudomembranes were again noted (ANC= 6.3/mm3). This time, fidaxomicin was started and FMT was performed 3 days later. He did not experience recurrence of CDI during the 6 months of follow-up. Importantly, no procedure related or infectious complications were noted. This case highlights the safety of FMT(s) in a patient with critically low ANC. Further experience is needed in this case scenario, however, FMT appears to be a viable option for the treatment of fulminant CDI in a severely neutropenic patient.