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Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Recurrent bacteremia and liver abscess caused by Clostridium difficile: A case report
Hiroshi Morioka1, Mitsutaka Iguchi, Teiji Kuzuya
1Department of Infectious Diseases, Nagoya University Hospital Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi Department of Clinical Infectious Diseases Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute, Aichi, Japan.
Rationale:
Clostridium difficile bacteremia (CDB) and liver abscess is a quite rare presentation of C. difficile infection.
Patients Concerns:
A 74-year-old male with primary biliary cirrhosis and hepatocellular carcinoma who underwent transarterial chemoembolization (TACE) developed a high fever on post-TACE day 14. Intravenous ceftriaxone and following meropenem were administered, however, his clinical response was poor. On post-TACE day 24, 2 sets of blood culture were taken due to elevation of C-reactive protein levels.
Diagnosis:
CDB, caused by bacterial translocation.
Interventions:
Intravenous vancomycin and oral metronidazole were administered for two weeks.
Outcomes:
One month after recurrent CDB, the patient was re-admitted due to a liver abscess at the same site of TACE. C. difficile was isolated from the liver abscess and the patient received 6 weeks of oral metronidazole treatment. CDB and liver abscess have not recurred since completion of antibiotic treatment.
Lessons:
The spore-forming ability of C. difficile may contributed to the recurrent CDB episodes and liver abscess formation in necrotic liver tissue following TACE, and long-term metronidazole therapy was considered to be effective to C. difficile liver abscess.
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