Case 10: Hospital Course

Here is the patient’s clinical course:

Our patient was admitted to the intensive care unit for management of severe fulminant C difficile colitis. He was treated with intravenous metronidazole and oral and rectal Vancomycin retention enema for colonic ileus. Disease progression was monitored with serial abdominal exams and imaging. On day 4 of hospitalization, our patient underwent colonoscopic fecal microbial transplantation (FMT). Colonoscopy was notable for pseudomembranes. After FMT, diarrhea improved. FMT was repeated two more times (day 9 and 12) with continued improvement and resolution of diarrhea and colonic dilation. On day 17, the patient was discharged.

Colonoscopy findings:
Here are representative colonoscopic images obtained on hospital days 4, 9, 12, and 17. Note that the extensive pseudomembranes (raised yellowish plaques overlying erythematous and edematous mucosa) seen on the initial colonoscopy (day 4) gradually resolve over our patient’s hospital course:

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