Elevated serum antibody response to toxin A following splenic abscess due to Clostridium difficile

Splenic abscess and segmental small-bowel infarction were documented in a patient from whose splenic culture Clostridium difficile was isolated. A week and a half after splenectomy and partial bowel resection, diarrhea developed and stool cultures yielded an isolate of C. difficile that was identical to the abscess isolate when subjected to restriction endonuclease analysis. The level of IgG antibody to toxin A was markedly higher in serum from this patient than in sera from patients with C. difficile diarrhea alone. This case illustrates a rare but serious extraintestinal manifestation of infection with C. difficile and suggests a correlation between serum levels of IgG antibody to toxin A and systemic exposure to C. difficile, a typically noninvasive enteric pathogen.