Community-acquired Clostridium difficile-associated diarrhea in a patient on chronic peritoneal dialysis

A 66-year-old woman on chronic peritoneal dialysis was admitted because of intermittent diarrhea and abdominal pain, and anorexia for 1 month. She had not been given antibiotics nor hospitalized for at least 6 months prior to the onset of symptoms. Clostridium difficile and its toxin were detected in the stool and Clostridium difficile-associated diarrhea (CDAD) was diagnosed. Colonoscopic examination revealed pseudo-membrane formation and colitis in the whole colon. Clostridium difficile and its toxin became negative 12 days after vancomycin administration. Thus, clinical suspicion to CDAD is important in dialysis patients presenting with abdominal symptoms even if it is apparently community-acquired with no history of antibiotic use and hospitalization.