An unusual presentation of Clostridium difficile colitis in a patient with Wegener’s granulomatosis

Clostridium difficile colitis (CDC) is a common hospital acquired infection with a wide range of clinical presentations. Severe cases often warrant surgical consultation and colectomy. A 54 year old woman being treated with corticosteroids for Wegener’s granulomatosis developed mild abdominal pain while in hospital. Subsequent CT scan revealed pneumatosis of the ascending colon, portal venous gas and extraluminal air. Although the patient was afebrile and hemodynamically stable surgery was recommended based on these imaging findings. At laparotomy the ascending colon was found to have circumferential pneumatosis and signs of ischemia. A right hemicolectomy was performed. The patient developed diarrhea on the fifth postoperative day and C. difficile toxin was detected in her stool. Oral metronidazole was started and the patient responded well to the therapy. Pathology demonstrated ischemia of the resected colon secondary to C. difficile infection. This case of a patient with an unusual presentation of severe CDC in the setting of stable vital signs will be presented and the relevant literature will be reviewed.