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[Diarrhea due to Clostridium difficile toxin in hemato-oncological patients]
J M Kerst1, J van der Lelie, E J Kuijper
1Afd. Inwendige Geneeskunde, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ Amsterdam. j_kerst@nki.nl
Nederlands Tijdschrift Voor Geneeskunde
|July 4, 2001
Summary
Diarrhoea in multiple myeloma patients undergoing chemotherapy can be caused by Clostridium difficile infection. Early diagnosis and antibiotic treatment lead to rapid recovery, even when initial tests are negative.
Area of Science:
- Hematology
- Oncology
- Infectious Diseases
Background:
- Multiple myeloma patients often experience chemotherapy-induced diarrhea.
- Vincristine, doxorubicin, and dexamethasone (VAD) chemotherapy is a common treatment regimen.
Observation:
- Two multiple myeloma patients developed diarrhea during or after VAD chemotherapy and stem cell mobilization.
- One patient initially presented with pseudomembranous colitis, but initial Clostridium difficile testing was negative.
Findings:
- Clostridium difficile infection was confirmed in both patients, despite a false-negative initial immunoassay in one case.
- The bacterium was cultured, and toxins were detected in repeat testing, confirming C. difficile enterotoxin presence.
- Antibiotic therapy resulted in rapid clinical improvement for both patients.
Implications:
- Chemotherapy-associated diarrhea in hematologic-oncology patients warrants consideration of C. difficile infection.
- Prompt diagnosis and treatment of C. difficile can significantly improve patient outcomes.
- Diagnostic challenges, including false-negative initial tests, should be recognized in immunocompromised patients.