P0228 - Cisplatin-Induced Recurrent Clostridium difficile Infection

Sudhir Reddy. Pasham, MD¹, Rajachandra Chakinala, MD¹, Manidhar Lekkala, MD², Saisree Reddy Adla Jala, MD³, Rewanth Katamreddy, MD⁴, Sravan Ponnekanti, MD¹, Anirudh R. Damughatla, DO⁵, Pragna Koleti, MD⁶, Bikal Lamichanne, MD¹, Balakrishna Ravella, MBBS, MD^7
1Guthrie Robert Packer Hospital, Sayre, PA; ²University of Kansas Medical Center, Kansas, KS; ³Centinela Hospital Medical Center, Los Angeles, CA; ⁴Saint Michael’s Medical Center, Newark, NJ; ⁵Wayne State University School of Medicine / Detroit Medical Center, Detroit, MI; ⁶Suburban Community Hospital, Norristown, PA; ⁷OSF Health St. Mary's Medical Center, Galesburg, IL

Introduction: A C.difficile infection (CDI) can be self-limiting or develop into fulminant colitis, ileus, or toxic megacolon, which are serious and potentially fatal conditions. Patients taking cancer chemotherapy without previous antibiotic medication have been observed to develop colitis and infections caused by Clostridium difficile. Chemotherapeutic drugs can modify the natural bowel flora and lead to significant intestinal inflammation, which promotes C. difficile growth and toxin generation. Our case identified Clostridium difficile colitis in ovarian cancer patients following each infusion of cisplatin-based combination chemotherapy.

Case Description/Methods: 71-year-old female, PMH of hypertension, hypothyroidism, ovarian cancer. Patient presented to ED with Grade 1 diarrhea for 4 days following 2 weeks of chemotherapy, associated Lethargy and abdominal cramps. Diarrheal episodes are watery, 3-4 bowel movements per day, No melena or hematochezia. Review of systems positive for dizziness, anxiety, subjective shortness of breath. Patient denied any fever, chills, hematemesis, hemoptysis, cough, chest pain. Vitals stable, Abdominal examination is soft and non-tender. Labs: Bicarb 8, Hemoglobin 5.8 gm/dl, Positive for C. difficile GDH Antigen & Toxin A along with B, Negative for other GI infectious organisms. CT abdomen: minimal ascites, diffuse colitis. Treated with 2 Units of PRBC’s transfusion. For C.difficile after first 2 chemotherapy cycles, treated with vancomycin for the initial 2 episodes. Treated with Fidaxomicin following the 3 consecutive chemotherapy cycles

Discussion: Adults with cancer had a 7%-14% higher incidence of Clostridium difficile infection (CDI) than the overall hospitalized population (1%-2%). Although there is a dearth of data, it appears that the varied symptoms, treatment, and outcome are identical to those for instances associated with antibiotics. Chemotherapy related diarrhea due to inflammation unlike C.difficile infection is known to us in literature. It's possible that C. difficile infections linked to chemotherapy go unreported because they are not suspected or because their true prevalence is hidden by frequent concurrent antibiotic use. Every time a patient receiving antineoplastic treatment experiences diarrhea, C. difficile infection should be considered. Early therapy and prompt, appropriate diagnostic testing may prevent morbidity and death.


Disclosures:


Sudhir Reddy. Pasham, MD¹, Rajachandra Chakinala, MD¹, Manidhar Lekkala, MD², Saisree Reddy Adla Jala, MD³, Rewanth Katamreddy, MD⁴, Sravan Ponnekanti, MD¹, Anirudh R. Damughatla, DO⁵, Pragna Koleti, MD⁶, Bikal Lamichanne, MD¹, Balakrishna Ravella, MBBS, MD⁷. P0228 - Cisplatin-Induced Recurrent Clostridium difficile Infection, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.