SHM Converge Scientific Abstract ePoster Gallery-Clostridium Difficile as the Primary Cause of Ascites in the Hospitalized Patient and the Efficacy of Fidaxomicin as Its Treatment

Clostridium Difficile as the Primary Cause of Ascites in the Hospitalized Patient and the Efficacy of Fidaxomicin as Its Treatment

Back to course

Pdf Summary

An 88-year-old woman with hypertension, atrial fibrillation, and HFpEF presented after a mechanical fall with a right proximal femur fracture. On exam, her right leg was shortened and externally rotated. She also had abdominal distension with a fluid wave, mild bibasilar crackles, and oxygen saturation of 92% on room air. Imaging confirmed the femur fracture, showed patchy bilateral pulmonary opacities with small pleural effusions, and abdominal ultrasound revealed small ascites.<br /><br />The case report highlights an unusual cause of ascites in hospitalized patients: Clostridium difficile infection. The patient was initially diagnosed with spontaneous bacterial peritonitis (SBP) and C. difficile colitis, and was treated with ceftriaxone plus oral vancomycin. However, her ascites and peritonitis worsened despite therapy. Further evaluation showed a low SAAG and rising ascitic fluid neutrophil count, leading to the diagnosis of C. difficile ascites as the likely cause of refractory SBP.<br /><br />This condition is rare, with only a small number of cases reported in the literature. Prior cases have often responded to oral vancomycin, but this patient’s infection was refractory to it. She ultimately improved with fidaxomicin.<br /><br />Key takeaways:<br />- C. difficile should be considered in the differential diagnosis of ascites in hospitalized patients, especially if diarrhea is present.<br />- C. difficile can cause refractory spontaneous bacterial peritonitis.<br />- A low SAAG and high ascitic ANC may support the diagnosis.<br />- Fidaxomicin may be effective when oral vancomycin fails.

Asset Subtitle

Andrew Young

Meta Tag

Author List Andrew Young, Weihuang Ning, Yasuko M. Mano

Category Clinical Vignettes

Concept Clostridioides difficile Infection

Concept Cirrhotic Ascites

Concept Spontaneous Bacterial Peritonitis

Concept Serum-Ascites Albumin Gradient

Concept Pseudomembranous Colitis

Distinguished Non-Finalist

Presenter Organization Keck School of Medicine of USC

Presenting Author Andrew Young

Track Adult

Keywords

Clostridium difficile

ascites

spontaneous bacterial peritonitis

refractory infection

fidaxomicin

oral vancomycin

low SAAG

ascitic neutrophils

hospitalized patients

case report

Clostridioides difficile Infection

Cirrhotic Ascites

Spontaneous Bacterial Peritonitis

Serum-Ascites Albumin Gradient

Pseudomembranous Colitis