C Diff Case Studies

A 51 year old Hispanic woman was readmitted for the fifth time, with nausea, vomiting, diffuse abdominal pain and diarrhea. During her initial presentation, she was diagnosed with Clostridium difficle colitis (C diff) and during the subsequent admissions, she remained positive for C diff and is currently on a vancomycin taper for treatment of recurrent C diff. Over the past several admissions, she was found to have bacteremia with organisms such as Saccharomyces cerevisiae, Eubacterium lentum, Enterococcus faecalis and Acinetobacter lwoffi. On examination, she had diffuse abdominal and renal angle tenderness. Renal function was normal, without evidence of microscopic or macroscopic hematuria. She was found to have an elevated ESR, AST, ALT and alkaline phosphatase with normal bilirubin levels. Imaging studies including abdominal ultrasound, CT abdomen and pelvis, MR angiogram of the abdomen and pelvis, were unremarkable. Work-up such as ANA, ANCA, HIV and hepatitis panel were normal. Colonoscopy and upper endoscopy were negative. …show more content…
As the exact details of her diagnosis and treatment course were unclear, her previous medical records were requested. At the time the diagnosis was made, she had fever and abdominal pain. She was found to be in acute renal failure and had gross hematuria. All the work-up done at that time, including the renal biopsy was negative, with the exception of renal angiogram which revealed changes consistent with PAN. She completed a course of cyclophosphamide and steroids over the span of 18 months, with complete resolution of symptoms and normalization of the renal angiogram. Thereafter, she was lost to follow up, until she established care at our