Case 10: Summary

Fulminant Clostridium difficile infection with toxic megacolon.

Diagnosis Summary:
C. difficile infection is a common cause of infectious diarrhea, especially in presence of risk factors such as older age (>65 years), hospitalization or nursing home stay, antibiotic use and immunocompromised states. The 2-step algorithm used to make a diagnosis is shown in Figure 1. Classification of severity of infection is performed based on the features outlined in Figure 2. For severe fulminant infection a combination of oral and rectal vancomycin, parenternal metronidazole and fecal microbiota transplantation is recommended.


Two-Step Diagnostic Algorithm (Figure 1):Picture1cdiff

Classification of Disease Severity (Figure 2):Screen Shot 2021-10-31 at 2.57.24 PM

Case authored by:  Shabari Shenoy MD, Jiyoon Yoon MD, and Bhavana Bhagya Rao MD


  1. Czepiel J, Dróżdż M, Pituch H, et al. Clostridium difficile infection: review. Eur J Clin Microbiol Infect Dis. 2019;38(7):1211-1221. doi:10.1007/s10096-019-03539-6
  2. Stuart Johnson, Valéry Lavergne, Andrew M Skinner, et al. C. difficile 2021 Focused Update. Accessed August 14, 2021.
  3. Kelly CR, Fischer M, Allegretti JR, et al. ACG Clinical Guidelines: Prevention, Diagnosis, and Treatment of Clostridioides difficile Infections. Official journal of the American College of Gastroenterology | ACG. 2021;116(6):1124-1147. doi:10.14309/ajg.0000000000001278

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