Introduction: Clostridium Difficile is a notorious gastrointestinal pathogen well known to cause infectious gastroenteritis with the predominant complain being profuse secretory diarrhea. While severe cases of C diff can lead to pseudomembranous colitis and subsequent toxic megacolon, this is usually avoided with prompt recognition of infection owing primarily to the presenting complaint of diarrhea. Infrequently however, C diff infections can result in fulminant colitis without the preceding diarrhea phase which can make diagnoses challenging and lead to further complications such as toxic megacolon and colon perforation. Herein, we present a rare case of toxic megacolon in a patient who ended up receiving a total colectomy and was found to have C diff without any preceding diarrhea.
Case Description/Methods: A 69-year-old male with a past medical history of coronary artery disease (CAD) status post coronary artery bypass graft (CABG) 4 weeks prior, type 1 diabetes, and hypothyroidism presented to the hospital with fever and abdominal pain after consuming spoiled pasta 2 days after traveling 16 hours by car. The patient had no prior diarrhea and was admitted for evaluation of possible thromboembolism and gastroenteritis. Lab results revealed acute kidney injury (AKI) with a lactic acidosis, leukocytosis with a left shift, and bandemia. CT imaging showed severe diffuse inflammation and dilation of the colon with sparing of the rectosigmoid colon, suggestive of severe colitis with secondary ileus.
The patient developed an acute abdomen and underwent total abdominal colectomy with end ileostomy. Intraoperative findings confirmed toxic megacolon. Following the procedure stool samples were positive for C. difficile antigen and toxin with subsequent microbiological analysis of the gastrointestinal aspirate also positive. The patient was treated with oral vancomycin and intravenous (IV) Flagyl, with infectious diseases consultation for bezlotoxumab evaluation.
Discussion: This case report highlights a rare presentation of severe C. difficile colitis without prior diarrhea in a patient with significant comorbidities. Early recognition, appropriate diagnostic workup, and prompt surgical intervention were crucial in the successful management of this life-threatening condition. Further research is needed to understand the factors that may contribute to this atypical presentation of acute C. difficile colitis without any diarrhea.
Ethan Chambers indicated no relevant financial relationships.
Amyr Sayed indicated no relevant financial relationships.
Alishan Nasir indicated no relevant financial relationships.
Michael Slater indicated no relevant financial relationships.
Ethan Chambers, MD1, Amyr Sayed, MD2, Alishan Nasir, MD2, Michael Slater, DO2. P1632 - A Rare Case of C. difficile Colitis Without Prior Diarrhea Leading to Colectomy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.