Association of ulcerative colitis and Clostridium difficile infection at pediatric age – case presentation

Abstract

Introduction. Ulcerative colitis (UC) is a more severe pathology in children than adults, with an increasing incidence in young ages. The most common exacerbations are due to Clostridium difficile (CD) infection and can lead to severe complications. Case presentation. We present the case of a 6-year-old patient diagnosed with ulcerative colitis at the age of 5, admitted in our Clinic for watery diarrheic stools with blood, abdominal pain, anorexia, and weight loss. Laboratory tests at the time of admission revealed anemia, leukocytosis with neutrophilia, hydro-electrolytic disorders, and severe hypoalbuminemia. The A and B toxin detection test for CD in feces was positive, stool culture was negative. Anamnestic, clinical and paraclinical data established the diagnosis of CD infection associated with exacerbation of UC. Initially, the evolution under pulse therapy with Solu-Medrol and Metronidazole by vein was slightly favorable, but with a period of decline 5 days after the per oral administration of corticosteroids. Therefore, it was necessary to reinitiate intravenous corticosteroids associating also Vancomycin orally. Under the established treatment the symptomatology improved, with the normalization of the laboratory parameters and after 21 days of admission the patient was discharged. Conclusions. The coexistence of CD infection in pediatric patients with UC remains a real challenge, due to the high rate of recurrence and higher mortality compared to the general population. The undulating evolution under treatment, as well as the psychological profile of the patient, have customized the case.

Keywords

• ulcerative colitis
• exacerbation
• clostridium difficile
• management