Clostridium difficile colitis in an immunocompromised patient treated with fidaxomicin

The incidence of C. difficile -associated colitis has significantly increased in recent years in hospitals and long-term healthcare facilities. It has a great impact on morbidity and mortality, particularly in high-risk patients (e.g. elderly and subjects with comorbidities or immunosuppression), who frequently have severe or recurrent infections and sometimes do not respond to conventional therapy with metronidazole or vancomycin. Fidaxomicin, recently approved in clinical use, is a new option for the treatment of C. difficile infections. A 65-year-old woman with cryptogenetic decompensated cirrhosis underwent orthotopic liver transplantation and started immunosuppressive therapy. She had a prolonged hospitalization of nine months after transplantation with several infectious complications and numerous episodes of severe C. difficile -associated colitis. Metronidazole and vancomycin were not completely effective. Fidaxomicin showed a sustained clinical cure without other recurrence.