Rare Presentation of Splenic Abscess Secondary to Clostridioides difficile Infection in a Patient With Systemic...

Splenic abscesses are rare but serious infections often linked to immunosuppressive conditions. While Clostridioides difficile is well-known for causing colitis, its occurrence in locations outside the gastrointestinal tract, like the spleen, is exceedingly rare. This report highlights a unique case of a C. difficile splenic abscess in a patient with systemic sclerosis and multiple comorbidities.  A 73-year-old female with a history of systemic sclerosis, recent colectomy with end ileostomy for fulminant C. difficile colitis, and other significant comorbidities, presented with abdominal pain, nausea, and decreased ostomy output. A CT scan revealed an organized splenic infarction with surrounding fluid collection, as well as a right parastomal hernia. The initial management included intravenous (IV) piperacillin-tazobactam, oral vancomycin, and IV fluids. Surgical consultation determined that immediate intervention was unnecessary, and a follow-up was planned. An interventional radiologist performed aspiration of the fluid collection, which was positive for C. difficile. Infectious Disease specialists subsequently recommended a 3-week course of oral metronidazole, and the patient was discharged with symptom control on an oral pain regimen.  There are many diagnostic and therapeutic challenges posed by extraintestinal C. difficile infections. Splenic abscesses caused by C. difficile are rare, and their variable clinical presentations can lead to delays in diagnosis. Currently, no standardized guidelines exist for managing such infections, making individualized treatment essential. The successful management of our patient's infection involved advanced imaging, percutaneous drainage, and tailored antibiotic therapy. Given the potential for antibiotic resistance and recurrence, prolonged follow-up and careful management are recommended.  Extraintestinal C. difficile infections, such as splenic abscesses, are rare and complex, highlighting the need for further research to develop standardized diagnostic and therapeutic protocols. This case contributes to the limited literature on this rare entity, underscoring the importance of a multidisciplinary approach in optimizing patient outcomes.