Case Study: Atypical Presentation of C.

Difficile Infection

A 64 years old lady was hospitalized after a complaint of pain in her abdomen at

emergency department of hospital. For which there were no proper evidences or aggravating

factors, and there was no relation with consumption of food. It was initially noticed as problem

of nausea and one episode of non-bloody and non-bilious vomiting. But in her past history it was

reviled that she has history of chronic obstructive pulmonary disease, hypertension, pancreatitis

secondary to cholelithiasis. and consequent stricture and bowel obstruction. At this stage her

complications were managed and situation was controlled with transverse loop colostomy,

adhesion lysis and segmental small bowel resection. A day later she was discharged with

medicines prescribed trimethoprim/sulfamethoxazole,800/160 mg po bid, vancomycin, 125 mg

po qid for 3 weeks, clindamycin, 300 mg po tid for 2 weeks. After discharge her condition got

better for 6 weeks. Daily colostomy output was noted 400 ml. there was no noticeable change in

the frequency of output and there was no mucus discharge or blood noticed from the colostomy.(

Salman A K.,et al., 2016).

During Examination, she was afebrile and hemodynamically stable. Over her abdomen

mild tenderness was noticed. Other systemic examinations were found to be very normal. Her

blood reports showed (Salman A K.,et al., 2016).

Test Name Result Normal value

Platelet 317 x 109/L 150 x 109/L

Hemoglobin 9.4 g/dl 12-15 g/dl

 leukocyte count 30 x 109/L 11 x 109/L

Her LFTs (liver function tests) and renal tests were normal. There was no source of

infection found in X-ray (Chest) and Blood, urine cultures. There were no substantial evidence

of any complications found in CT Scan (computer tomography) of the abdomen and pelvis. She

was prescribed with oral vancomycin 125 mg po qid suspecting C. difficile whereas some of the

results and reports were awaited. There was a remarkable improvement seen in her symptoms

WBC Count reduced to 13,000 x 109/L the following day. With the stool PCR she was diagnosed

and C. difficile was confimed. Her health improved and she was discharged from hospitalization

after 6 days. (Salman A K.,et al., 2016).

 References

Salman A K.,et al. (2016 April 8). Atypical Presentation of C. Difficile Infection: Report of a

Case with Literature Review. 8(4): e563. doi:10.7759/cureus.563