Fulminant Clostridioides difficile Colitis With SARS-CoV-2 Infection

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Gastroenterology

Background:

• Coronavirus disease 2019 (COVID-19) and Clostridioides difficile (C. difficile) infections share overlapping symptoms.
• Coinfections between these pathogens are increasingly studied for their impact on patient outcomes.
• Elderly patients with comorbidities are particularly vulnerable to severe infections.

Observation:

• An 83-year-old female with Parkinson's disease (PD) presented with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pneumonia.
• She received empiric antibiotics, remdesivir, baricitinib, and dexamethasone.
• The patient subsequently developed a severe C. difficile infection with a leukemoid reaction, progressing to fulminant colitis despite treatment.

Findings:

• The patient's coinfection and comorbidities contributed to a severe clinical course.
• Treatment with intravenous metronidazole and oral vancomycin was ineffective.
• Fulminant colitis necessitated emergent surgery, leading to complications and patient demise.

Implications:

• This case underscores the critical need for judicious antibiotic stewardship.
• It raises questions about the role of immunosuppressive antiviral medications in predisposing patients to severe C. difficile infections.
• The interplay between underlying conditions like Parkinson's disease and infection severity warrants further investigation.