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Published on: December 8, 2014
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Extraintestinal Clostridium difficile infection presenting as spontaneous bacterial peritonitis
Bilal Hafeez1, Tess Aitken2, Ella Cockburn3
1Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia.
BMJ Case Reports
|February 11, 2025
Summary
A rare case of extraintestinal Clostridioides difficile infection (CDI) presented as spontaneous bacterial peritonitis in a woman with cirrhosis. Successful treatment with metronidazole highlights a unique clinical presentation of CDI.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Microbiology
Background:
- Clostridioides difficile infections (CDIs) are primarily intestinal but can manifest extraintestinally, a rare clinical scenario.
- Extraintestinal CDIs constitute a small percentage of all CDIs (0.17%-1.08%) and are often polymicrobial.
- Spontaneous bacterial peritonitis (SBP) caused by C. difficile is exceedingly rare, with limited reported cases, predominantly in male patients with cirrhosis.
Purpose of the Study:
- To report a unique case of monomicrobial extraintestinal Clostridioides difficile infection presenting as spontaneous bacterial peritonitis.
- To discuss the diagnostic and therapeutic challenges associated with this rare presentation of CDI.
- To contribute to the limited literature on extraintestinal manifestations of C. difficile.
Main Methods:
- A case study approach was employed, detailing the clinical presentation, diagnostic workup, and treatment of a patient with cirrhosis and SBP.
- Ascitic fluid analysis, including cell counts and microbial cultures, was performed.
- Imaging studies were utilized to exclude secondary causes of peritonitis.
Main Results:
- A woman with cirrhosis developed spontaneous bacterial peritonitis (SBP) caused by monomicrobial extraintestinal Clostridioides difficile.
- The patient was asymptomatic for infection, with diagnosis confirmed via routine paracentesis and ascitic fluid cultures.
- Successful treatment was achieved with metronidazole, and imaging ruled out other causes of peritonitis.
Conclusions:
- This case underscores the potential for Clostridioides difficile to cause monomicrobial extraintestinal infections like SBP, even in the absence of typical risk factors.
- Management of extraintestinal CDI, particularly SBP, presents complexities and requires careful consideration of diagnostic and therapeutic strategies.
- Further research is warranted to understand the epidemiology and optimal treatment of rare extraintestinal manifestations of C. difficile.
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