Pham Charles Dac, Hua Duong Tommy
Division of Hospital Medicine, Department of Medicine, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA, 90502, USA.
J Med Case Rep. 2021 Jan 5;15(1):2. doi: 10.1186/s13256-020-02592-6.
Clostridium difficile (C. difficile) is a common cause of infectious colitis in individuals with prior antibiotic or hospital exposure. Extraintestinal manifestations of C. difficile infections, however, are rare. Here we present a case of C. difficile appendicitis in an immunocompromised patient.
A 53-year-old Caucasian male presented to the emergency room for two days of lower abdominal pain associated with nausea and subjective fevers. He otherwise denied having diarrhea or hematochezia. He did not have any recent hospitalizations, nursing home stays, or antibiotic exposure. His past medical history was notable for stage III tonsillar squamous cell carcinoma for which he was status post tonsillectomy, radiation therapy, and chemotherapy (cisplatin 4 days prior to presentation). He was afebrile with tenderness to palpation in the bilateral lower quadrants, right greater than left. His white blood cell (WBC) count was 15.6 × 10 cells/μL. Computed tomography (CT) of the abdomen and pelvis showed marked edema and inflammation of the cecum and ascending colon as well as an enlarged appendix with surrounding inflammatory changes with a small amount of free fluid in the right paracolic gutter. He was treated non-surgically with antibiotics. He did not clinically improve and on hospital day 3, he developed diarrhea for which C. difficile stool polymerase chain reaction was sent. Repeat CT of the abdomen and pelvis was performed which showed progression to pan-colitis and persistent appendicitis. C. difficile testing later resulted positive, for which oral vancomycin was started. The patient markedly improved with medical management alone and was subsequently discharged on oral vancomycin.
Our case highlights the importance of maintaining a high index of suspicion for C. difficile in a patient presenting with both appendicitis and colitis, with prompt diagnosis and treatment being essential.
艰难梭菌是既往有抗生素使用史或住院史个体感染性结肠炎的常见病因。然而，艰难梭菌感染的肠外表现较为罕见。在此，我们报告一例免疫功能低下患者发生的艰难梭菌性阑尾炎病例。
一名53岁的白种男性因下腹部疼痛伴恶心和自觉发热两天就诊于急诊室。他否认有腹泻或便血。他近期没有住院、入住疗养院或使用过抗生素。他既往有III期扁桃体鳞状细胞癌病史，已行扁桃体切除术、放疗和化疗（就诊前4天使用过顺铂）。他体温正常，双侧下腹部触诊有压痛，右侧重于左侧。他的白细胞计数为15.6×10⁹/L。腹部和盆腔计算机断层扫描（CT）显示盲肠和升结肠明显水肿和炎症，阑尾肿大，周围有炎症改变，右侧结肠旁沟有少量游离液体。他接受了抗生素非手术治疗。他的临床症状未改善，在住院第3天出现腹泻，遂送检艰难梭菌粪便聚合酶链反应。再次进行腹部和盆腔CT检查，结果显示进展为全结肠炎和持续性阑尾炎。艰难梭菌检测后来结果呈阳性，为此开始口服万古霉素治疗。仅通过药物治疗，患者病情明显好转，随后口服万古霉素出院。
我们的病例强调了对于同时患有阑尾炎和结肠炎的患者，对艰难梭菌保持高度怀疑的重要性，及时诊断和治疗至关重要。
