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BMJ Case Reports 2012; doi:10.1136/bcr-2012-007273
  • Rare disease

Concomitant Clostridium difficile colitis and cytomegalovirus colitis in an immunocompetent elderly female

  1. Mackenzie Morgan
  1. Department of Internal Medicine, Madigan Army Medical Center, Tacoma, Washington, USA
  1. Correspondence to Dr Maria Kurtz, maria.kurtz{at}amedd.army.mil

Summary

A 78-year-old Japanese woman with diarrhoea and abdominal pain was admitted for PCR test (PCR)-proven Clostridium difficile colitis. The patient's symptoms persisted despite multiple courses of antibiotics including intravenous metronidazole, oral  vancomycin and oral fidaxomicin. She underwent a stool transplant without improvement. Biopsies from a colonoscopy revealed concomitant cytomegalovirus (CMV) infection. The patient was immediately started on intravenous ganciclovir. Unfortunately, she developed sepsis secondary to colitis, and underwent definitive treatment with a total colectomy. Although CMV is a rare colonic pathogen in the immunocompetent patient, it should be considered in patients with severe or refractory C difficile colitis.

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