Clostridioides Difficile Enteritis: Case Report and Literature Review

Abstract

Background: Clostridioides Difficile is a well-known pathogen causing diarrhea of various degrees of severity through associated infectious colitis. However, there have been reports of infectious enteritis mainly in patients with ileostomy, causing dehydration through high-output volume; Case presentation: We report the case of a 46-year-old male patient, malnourished, who presented with high-output ileostomy following a recent hospitalization where he had suffered an ileo-colic resection with ileal and transverse colon double ostomy, for stricturing Crohn’s disease. Clostridioides Difficile toxin A was identified in the ileal output confirming the diagnosis of acute enteritis. Treatment with oral Vancomycin was initiated with rapid reduction of the ileostomy output volume; Conclusion: We report a case of Clostridioides Difficile enteral infection as a cause for high-output ileostomy, successfully treated with oral Vancomycin. We also review the existing literature data regarding this specific localized infection.

Uncommon Presentation of Clostridioides difficile in the Small Bowel: A Case Report and Review of Literature

“…Patients have ileus, making it difficult to institute oral vancomycin, which is the standard of care. Another challenge is the high mortality rate of approximately 30% [ 6 ].…”

Strongyloides stercoralis hyperinfection syndrome mimicking pseudomembranous enteritis, complicated by Escherichia coli bacteremia and Pneumocystis jirovecii pneumonia in a patient after immunosuppressive therapy: a case report

“…Both abdominal CT may display thickening of the intestinal wall. Cephalosporins and Fluoroquinolones account for the top two medications in the predisposing antibiotic use to Clostridioides difficile infection (CDI) [ 11 ]. Enzyme immunoassays for toxins and glutamate dehydrogenase (GDH) for the detection of CDI are not available in our hospital.…”

Clostridium difficile Enteritis With NAP7/078 Toxigenic Strain

“…However, no data regarding specific strains were reported. Klimko et al provided an updated review of C difficile enteritis in 2022, describing 77 cases over the last 20 years, also without data on toxigenic strains [ 2 ]. Interestingly, in one of the publications included in this review, Lavallée et al described the first case of C difficile enteritis caused by the NAP1/027 strain and hypothesized that NAP1/027 may be able to colonize small bowel more easily [ 3 , 4 ].…”

“…The 2021 Infectious Diseases Society of America update on C difficile management does not provide recommendations for C difficile enteritis [ 8 ]. In the reviews from Freiler et al [ 1 ] and Klimko et al [ 2 ], dual therapy with parenteral metronidazole and enteral vancomycin was used in most cases. Klimko et al also described vancomycin enemas per distal limb of conduit in several patients with stomas.…”

“…Although a rare and perhaps underdiagnosed entity, C difficile enteritis has been increasingly reported over the last 2 decades, and it carries a mortality rate of up to 30% [ 2 , 9 ]. There is a knowledge gap in the role of toxigenic strains in C difficile enteritis, and genotyping in future cases can further our understanding of this.…”