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Fulminant Clostridium difficile toxic megacolon in a pediatric heart transplant recipient
Angira Patel1, Jeffrey J Gossett, Tara Benton
1Division of Cardiology, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60614, USA.
Insights
Clostridium difficile (CD) infection can cause severe diarrhea and toxic megacolon in pediatric heart transplant patients. Prompt surgical intervention is crucial for managing complications like abdominal compartment syndrome.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Transplant Medicine
Background:
- Clostridium difficile (CD) infection is a known cause of diarrhea in pediatric heart transplant recipients.
- Immunocompromised status in these patients increases the risk of severe CD-related complications.
Observation:
- A 10-year-old girl, a pediatric heart transplant recipient, presented with CD-associated diarrhea.
- Her condition rapidly progressed to fulminant colitis, exhibiting signs of toxic megacolon and abdominal compartment syndrome.
Findings:
- The patient required emergent surgery, revealing toxic megacolon.
- A sub-total abdominal colectomy and end-ileostomy were performed, leading to a swift recovery.
Implications:
- Early recognition of severe CD and its complications, such as abdominal compartment syndrome, is critical in post-transplant pediatric patients.
- Heightened clinical suspicion and aggressive management are recommended for diarrhea in pediatric heart transplant recipients due to the risk of fulminant CD and toxic megacolon.
Abstract:
CD can be a cause of diarrhea in pediatric heart transplant recipients. Fulminant colitis can develop in immunocompromised patients with CD and progress to toxic megacolon. We report a case of a 10-yr-old girl who developed CD diarrhea and subsequently fulminant colitis with clinical signs and symptoms of abdominal compartment syndrome. She was taken to the operating room emergently and found to have toxic megacolon. She underwent a sub-total abdominal colectomy and end-ileostomy, and made a rapid recovery. Rapid recognition of the severity of the disease in the post-operative transplant patient is imperative as abdominal compartment syndrome may develop requiring surgical management. In pediatric heart transplant patients with diarrhea, we recommend a heightened clinical awareness with aggressive treatment given the risk of progression to fulminant CD and toxic megacolon.
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