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Novel treatment (new drug/intervention; established drug/procedure in new situation)
Case report
Management of difficult-to-treat Clostridioides difficile in a patient with chronic osteomyelitis
  1. Mikaela Highland Sullivan,
  2. Victoria Lynn Boggiano and
  3. Kelly Lacy Smith
  1. Department of Family Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Victoria Lynn Boggiano; victoria.boggiano{at}unchealth.unc.edu

Abstract

A 61-year-old male patient being treated with intravenous antibiotics for left foot osteomyelitis presented to the hospital septic, with several days of worsening abdominal pain, bloating and watery bowel movements. Investigation revealed that the patient had severe, treatment-resistant Clostridioides difficile colitis. He was initially treated with oral vancomycin and intravenous metronidazole, which was switched to oral fidaxomicin. After no improvement in the patient’s symptoms, he was treated with two faecal microbiota transplants. He was offered a third faecal microbiota transplant but declined. The patient was placed back on oral fidaxomicin and saw ultimate resolution of his symptoms. This case provides an example of a treatment pathway for refractory C. difficile infection.

  • gastroenterology
  • infection (gastroenterology)
  • infectious diseases
  • hepatitis and other gastrointestinal infection

https://doi.org/10.1136/bcr-2019-233095

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    Footnotes

    • Twitter @mikhsullivan, @vboggiano, @kellylacysmith1

    • Contributors Each author has contributed equally to the contents of this paper, and all are in agreement with its findings. KLS, VLB and MHS were all involved in caring for this patient while he was hospitalised. KLS and VLB were involved in the initial idea generation and data collection. MHS, VLB and KLS were involved in the data interpretation. MHS and VLB were involved in writing the first draft and obtaining patient consent. KLS edited the first draft and created the final draft.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.