Polymicrobial Clostridioides difficile lung empyema

Clostridioides (Clostridium) difficile is a well-known cause of enteritis and antibiotic-associated diarrhea. Extraintestinal C. difficile infection is uncommon, with most extraintestinal infections involving the intra-abdominal cavity and anatomic structures adjacent to the colon. Empyema secondary to C. difficile is especially rare, with only a handful of cases reported in the medical literature. A standard antibiotic treatment regimen for C. difficile empyema does not currently exist, and data chronicling successful treatment is limited. We present the case of an 80-year-old woman with a polymicrobial C. difficile empyema who was successfully treated with multiple chest tube insertions and intravenous vancomycin.