Clostridium difficile infection presenting as hematochezia: A case report

Abstract

Introduction: Clostridium difficile infection (CDI) caused by Clostridioides difficile, an organism capable of producing toxins, is the leading cause of antibiotic-associated diarrhea worldwide. It usually presents as watery diarrhea with mucus or occult blood and lower abdominal pain. Severe hematochezia is rarely seen with CDI.

Clinical Presentation: We discuss a case of an elderly female who initially presented with symptomatic anemia, and then severe hematochezia. Colonoscopy revealed varisized ulcers, and edematous and friable intervening mucosa. Histology revealed severe active inflammation, fibrinopurulent exudate, granulation tissue and reactive epithelial cell. The patient also tested positive for C. difficile toxin and antigen. The patient was then managed as CDI with vancomycin and mesalamine for 10 days, and clinically improved.

Conclusion: Although rare, CDI may present as hematochezia. Oral vancomycin is the drug of choice for treating CDI and mesalamine suppository may be given to improve colitis caused by CDI.