Case Presentation: The patient is a complex patient with multiple hospitalizations. Prior to her hospital course her past medical history was notable for Roux-en-Y gastric bypass, alcohol abuse, and dilated cardiomyopathy with preserved EF. Patient original presentation was related to a perforated marginal ulcer requiring laparoscopic Graham patch. The ICU course was complicated by an internal jugular thrombus requiring full anticoagulation. After anticoagulation was started patient had a splenic hemorrhage that spontaneously resolved. During her recovery process patient developed C difficile infection in her colon secondary to the large amount of antibiotics patient was on. This was treated with course of oral vancomycin with resolution of symptoms.After antibiotics were stopped for a week patient represented to hospital in septic shock. Source was unclear but initially imaging showed that the splenic hematoma looks infected on CT scan. Patient subsequently went IR drainage of the abscess for a culture sample to be obtained. Initial antibiotic coverage was completed with zosyn and vancomycin. After multiple days, blood and abscess cultures did result with C difficile in both locations. Patient status was also deteriorating at this point. This patient was transitioned to triple therapy with IV vancomycin, IV metronidazole, and IV tigecycline. Patient was also taken to operating room for an emergent splenectomy to assist in stabilization. Patient was ultimately unable to tolerate procedure and coded in OR. Patient was then transitioned to comfort cares and demise secondary to severe infection.
Discussion: Its primary location of infection is the colon and has been associated with toxic megacolon, one of the most feared complications as requires colectomy typically. Literature review shows only case reports of extra-colonic C difficile infections, and exceedingly rare reports of C difficile bacteremia.
Conclusions: Multi-drug regimens should be used for treatment with IV vancomycin and metronidazole at forefront. Often poly-microbial so other broad-spectrum antimicrobials should be continued.