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Clostridium difficile infection and disseminated candidiasis: case report A 53-year-old woman developed Clostridium difficile infection and disseminated candidiasis following treatment with mycophenolate for systemic sclerosis. The woman, who had non-specific colitis involving chronic non-bloody diarrhoea, presented with acute onset of bloody-watery stool with abdominal pain. Infectious colitis was suspected, for which she was treated with ciprofloxacin/metronidazole, but without significant improvement. One month prior to presentation, she started receiving mycophenolate [route and dosage not stated] for recently diagnosed systemic sclerosis. At presentation, her vital signs were as follows: HR 69 bpm, BP 100/69mm Hg and body temperature 98.7oF. She also exhibited tachypnoea. Physical examination revealed taut skin over her upper extremities and face, pitting oedema of her lower extremities, and necrosis of several digits of her hands. Laboratory investigations revealed following: hyponatraemia (sodium 127 mEq/L), bicarbonate levels of 20 mmol/L, WBC count 8.3 × 103, haemoglobin 9.8 mg/dL and platelet count 430 × 103/µL. PCR of stool sample appeared positive for Clostridium difficile. The woman started receiving treatment for C. difficile and began to show clinical improvement. A sigmoidoscopy revealed severe colitis of descending colon/sigmoid (rectal sparing), for which she started receiving unspecified, high-dose steroids. On the third day of admission, she developed severe, acute abdominal pain. Abdominal X-Ray revealed free air under the diaphragm, while an emergent laparotomy showed large quantities of faeces in the abdominal cavity, caecal perforation and ischaemic colon. The abdomen was washed out thoroughly, and total colectomy and end ileostomy were completed. She started receiving piperacillin/ tazobactam. She was clinically improving; however, on post-operative day 3, she abruptly became hypotensive. She developed a cardiac arrest and died soon after. Autopsy showed disseminated candidiasis, possibly due to gastrointestinal wall perforation. Haq M, et al. Cecal perforation with disseminated candidiasis in a patient with systemic sclerosis on mycophenolate. American Journal of Respiratory and Critical Care 803446388 Medicine 199: abstr. A3575, No. 9, May 2019. Available from: URL: https://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A3575 [abstract]

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Reactions 18 Jan 2020 No. 1787