P3-234A pivotal role of team medicine for recurrent ovarian cancer patient affected by Clostrioides difficile enterocolitis

Abstract Introduction Clostrioides difficile enterocolitis (CDAD) varies from asymptomatic soft feces to severe cases that cause intestinal perforation and toxic megacolon. We experienced a case of CDAD ovarian cancer that developed after multidisciplinary therapies without prior antibiotics administration. We here report a pivotal role of team medicine for CDAD. Case A 66-year-old woman had medical history of gastric cancer (endoscopic resection) at 60 years old. Her family history was as follows: father: prostate cancer; mother: breast cancer; maternal grandfather: gastric cancer; and maternal grandmother: rectal cancer. We conducted interval debulking surgery after 4 courses of paclitaxel and carboplatin (TC) therapy as the initial treatment in diagnosis of ovarian cancer stage IIIC (ypT3CpN0pM0, serous carcinoma). Six courses of TC therapy were postoperatively performed, but intraperitoneal recurrence was diagnosed 1 year and 10 months after the initial treatment. Then, 7 courses of TC and bevacizumab (Bev) therapy were performed followed by 9 courses of Bev maintenance treatment. A second recurrence (para-aortic lymph node) was confirmed 1 year and 2 months after the end of chemotherapy, and 3 courses of TC/Bev treatment and intensity-modulated radiation therapy (IMRT) were performed. On the 7th day after IMRT, she complained of fever, abdominal pain and bloody mucous stools. Although antibiotics were administered with a diagnosis of CDAD, CDAD relapsed during the treatment. In this case, we worked on patient mental support and infection spread prevention with nutritional management mainly based on oral intake. Conclusion In treatment of CDAD, multi-professional team medicine is essential. In gynecologic cancers where multidisciplinary therapies are performed, CDAD has been reported to be not rare. Both prompt diagnose and adequate multi-professional team medicines are considered to be important for CDAD.