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Published on: September 14, 2013
Atypical presentation of Clostridioides difficile pseudomembranous colitis with laboratory rejection of stool
1Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA wtung1@gmail.com.
Abstract:
Clostridioides (formerly Clostridium) difficile is a major cause of nocosomial infection in the USA and worldwide. It has a wide spectrum of presentation, ranging from an asymptomatic carrier state to fulminant colitis. Pseudomembranous colitis is a manifestation of severe C. difficile infection (CDI), typically with progressive symptoms including watery diarrhoea, abdominal cramping and fevers and elevated white cell count and/or creatinine. It is diagnosed on three levels, including clinical assessment, stool assays and visualisation of the colonic mucosa. Laboratories will reject stools that do not meet criteria for testing. In the era of molecular testing for the presence of toxigenic C. difficile DNA, which only indicates the potential for infection, it is vital to use clinical evaluation in the diagnosis of CDI. We present an atypical case of pseudomembranous colitis affecting the right colon in a patient whose stools were rejected multiple times for C. difficile testing.
Insights
Clostridioides difficile infection (CDI) can present atypically. This case highlights pseudomembranous colitis in the right colon despite repeated negative stool tests for C. difficile.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Clostridioides difficile infection (CDI) is a significant nosocomial pathogen.
- CDI presents with a broad clinical spectrum, from asymptomatic carriage to severe colitis.
- Pseudomembranous colitis is a severe manifestation of CDI.
Observation:
- Diagnosis of CDI involves clinical assessment, stool assays, and colonic visualization.
- Molecular testing for C. difficile DNA indicates potential infection but requires clinical correlation.
- This report details an atypical case of pseudomembranous colitis.
Findings:
- The patient presented with pseudomembranous colitis affecting the right colon.
- Stool samples were repeatedly rejected for C. difficile testing.
- Clinical evaluation was crucial despite negative stool assay results.
Implications:
- Emphasizes the importance of clinical judgment in diagnosing CDI, especially with atypical presentations.
- Highlights limitations of relying solely on stool assays for C. difficile diagnosis.
- Suggests a need for integrated diagnostic approaches in CDI management.
