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22 November 2013 : Case report  USA

A rare case intractable diarrhea secondary to Clostridium difficile and cytomegalovirus coinfection

Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Adverse events of drug therapy

Santhosh Gheevarghese JohnABCDEFG, Cristian DominguezDEF, Vijay ChandiramaniEF, Tejo VemulappalliEFG

DOI: 10.12659/AJCR.889700

Am J Case Rep 2013; 14:498-501

Abstract

Background: Coinfection with cytomegalovirus in a patient with Clostridium difficile persistent diarrhea and colitis can lead to a delay in diagnosis and treatment.
Case Report: A 63-year-old man with squamous cell carcinoma of the lower lip, status post surgical resection and currently on chemoradiation presented with intractable diarrhea and abdominal pain. Initial workup showed Clostridium difficile diarrhea with pancolitis. Diarrhea persisted despite being on antibiotics and bacteriological cure for C. difficile. Further noninvasive work up revealed associated cytomegalovirus infection, and patient had a dramatic response to ganciclovir without any relapse.
Conclusions: Physicians should be cognizant about other causes of diarrhea and colitis in immunocompromised patient when treatment for primary diagnosis fails to resolve their symptoms.

Keywords: Clostridium difficile, pancolitis, coinfection, intractable diarrhea

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923