Case 15.4
The patient is diagnosed with Clostridioides difficile infection.
The patient was initially prescribed vancomycin 125 mg 4x daily for 10 days and had resolution of diarrhea. However, her diarrhea subsequently returned one month after stopping treatment, and C. difficile testing was again positive for gene and toxin. She was treated with a vancomycin pulse/taper regimen. Again, her symptoms improved during the initial 10 days of treatment and did not recur over the course of the taper. However, 6 weeks after completing therapy, she had recurrent C. difficile infection.
For this second recurrence, she received one of the guideline-supported courses of antibiotics above. Once again, her symptoms respond to antibiotic therapy but recurred within 2 months of discontinuing antibiotics, and she was diagnosed with another episode of CDI on stool testing. She underwent a flexible sigmoidoscopy that showed very mild patchy erythema, an overall appearance of endoscopically quiescent UC, but with histology demonstrating mild active inflammation.