Rescue of fulminant Clostridioides difficile infection in a hemodialysis patient: a case report
Abstract Background Clostridioides difficile infection (CDI) is a gastrointestinal condition that arises from the disruption of normal intestinal flora, often caused by antibiotics or antiacids. Fulminant CDI, characterized by shock, intestinal obstruction, and toxic megacolon, has a poor prognosis....
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2025-07-01
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| Series: | Renal Replacement Therapy |
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| Online Access: | https://doi.org/10.1186/s41100-025-00656-1 |
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| author | Hiroyoshi Yanagisawa Megumi Oshima Keisuke Sako Yoshinori Takahashi Toshiaki Tokumaru Kaho Hayashi Megumi Ikeda Fumitaka Yamamori Sho Kajikawa Daiki Hayashi Takahiro Yuasa Keisuke Horikoshi Shiori Nakagawa Shinji Kitajima Tadashi Toyama Akinori Hara Norihiko Sakai Miho Shimizu Takumi Taniguchi Takashi Wada Yasunori Iwata |
| author_facet | Hiroyoshi Yanagisawa Megumi Oshima Keisuke Sako Yoshinori Takahashi Toshiaki Tokumaru Kaho Hayashi Megumi Ikeda Fumitaka Yamamori Sho Kajikawa Daiki Hayashi Takahiro Yuasa Keisuke Horikoshi Shiori Nakagawa Shinji Kitajima Tadashi Toyama Akinori Hara Norihiko Sakai Miho Shimizu Takumi Taniguchi Takashi Wada Yasunori Iwata |
| author_sort | Hiroyoshi Yanagisawa |
| collection | DOAJ |
| description | Abstract Background Clostridioides difficile infection (CDI) is a gastrointestinal condition that arises from the disruption of normal intestinal flora, often caused by antibiotics or antiacids. Fulminant CDI, characterized by shock, intestinal obstruction, and toxic megacolon, has a poor prognosis. Patients with chronic kidney disease and those on maintenance hemodialysis are at a higher risk for developing CDI, experiencing severe disease progression, and facing increased mortality. Case presentation A 70 years-old man with diabetic nephropathy undergoing maintenance hemodialysis for 2 years developed fulminant CDI. He had been on long-term antibiotic therapy for chronic pyogenic knee arthritis for 5 months. He presented with severe watery diarrhea, and stool tests confirmed CD toxins A and B. A computed tomography (CT) scan revealed toxic megacolon with pronounced intestinal edema, bowel dilatation, and massive pleural effusion. He was in shock and admitted to the intensive care unit. Treatment included massive fluid infusion, continuous vasopressor support, and regular human albumin infusions to stabilize circulation. Antibiotic therapy was initiated with oral vancomycin (2000 mg/day) and intravenous metronidazole (1500 mg/day). Advanced supportive measures included polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) and continuous renal replacement therapy using a cytokine adsorption column (SepXiris®). The patient’s condition gradually improved, and antimicrobial therapy was completed on day 25 of hospitalization. Follow-up computed tomography (CT) scans showed resolution of toxic megacolon, and there were no signs of CDI recurrence. The patient was eventually transferred to a rehabilitation facility. Conclusions Despite established treatments, fulminant CDI carries a high mortality rate, particularly in patients on maintenance hemodialysis, where fatal outcomes are common. This case highlights the successful management of fulminant CDI in a hemodialysis patient through a multitargeted approach, including intensive care, circulatory support with albumin monitoring, and advanced therapies such as PMX-DHP and cytokine adsorption. This report underscores the importance of comprehensive strategies in improving outcomes for high-risk patients. |
| format | Article |
| id | doaj-art-a02e0b00f87146ebbfaa99f3111af501 |
| institution | Kabale University |
| issn | 2059-1381 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | Renal Replacement Therapy |
| spelling | doaj-art-a02e0b00f87146ebbfaa99f3111af5012025-08-20T03:46:24ZengBMCRenal Replacement Therapy2059-13812025-07-011111510.1186/s41100-025-00656-1Rescue of fulminant Clostridioides difficile infection in a hemodialysis patient: a case reportHiroyoshi Yanagisawa0Megumi Oshima1Keisuke Sako2Yoshinori Takahashi3Toshiaki Tokumaru4Kaho Hayashi5Megumi Ikeda6Fumitaka Yamamori7Sho Kajikawa8Daiki Hayashi9Takahiro Yuasa10Keisuke Horikoshi11Shiori Nakagawa12Shinji Kitajima13Tadashi Toyama14Akinori Hara15Norihiko Sakai16Miho Shimizu17Takumi Taniguchi18Takashi Wada19Yasunori Iwata20Department of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nutrition, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Anesthesiology and Intensive Care Medicine, Graduate School of Medical Sciences, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityDepartment of Nephrology and Rheumatology, Kanazawa UniversityAbstract Background Clostridioides difficile infection (CDI) is a gastrointestinal condition that arises from the disruption of normal intestinal flora, often caused by antibiotics or antiacids. Fulminant CDI, characterized by shock, intestinal obstruction, and toxic megacolon, has a poor prognosis. Patients with chronic kidney disease and those on maintenance hemodialysis are at a higher risk for developing CDI, experiencing severe disease progression, and facing increased mortality. Case presentation A 70 years-old man with diabetic nephropathy undergoing maintenance hemodialysis for 2 years developed fulminant CDI. He had been on long-term antibiotic therapy for chronic pyogenic knee arthritis for 5 months. He presented with severe watery diarrhea, and stool tests confirmed CD toxins A and B. A computed tomography (CT) scan revealed toxic megacolon with pronounced intestinal edema, bowel dilatation, and massive pleural effusion. He was in shock and admitted to the intensive care unit. Treatment included massive fluid infusion, continuous vasopressor support, and regular human albumin infusions to stabilize circulation. Antibiotic therapy was initiated with oral vancomycin (2000 mg/day) and intravenous metronidazole (1500 mg/day). Advanced supportive measures included polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) and continuous renal replacement therapy using a cytokine adsorption column (SepXiris®). The patient’s condition gradually improved, and antimicrobial therapy was completed on day 25 of hospitalization. Follow-up computed tomography (CT) scans showed resolution of toxic megacolon, and there were no signs of CDI recurrence. The patient was eventually transferred to a rehabilitation facility. Conclusions Despite established treatments, fulminant CDI carries a high mortality rate, particularly in patients on maintenance hemodialysis, where fatal outcomes are common. This case highlights the successful management of fulminant CDI in a hemodialysis patient through a multitargeted approach, including intensive care, circulatory support with albumin monitoring, and advanced therapies such as PMX-DHP and cytokine adsorption. This report underscores the importance of comprehensive strategies in improving outcomes for high-risk patients.https://doi.org/10.1186/s41100-025-00656-1Fulminant Clostridioides difficile infectionToxic megacolonChronic kidney diseaseMaintenance hemodialysisPolymyxin B-immobilized fiber column direct hemoperfusion |
| spellingShingle | Hiroyoshi Yanagisawa Megumi Oshima Keisuke Sako Yoshinori Takahashi Toshiaki Tokumaru Kaho Hayashi Megumi Ikeda Fumitaka Yamamori Sho Kajikawa Daiki Hayashi Takahiro Yuasa Keisuke Horikoshi Shiori Nakagawa Shinji Kitajima Tadashi Toyama Akinori Hara Norihiko Sakai Miho Shimizu Takumi Taniguchi Takashi Wada Yasunori Iwata Rescue of fulminant Clostridioides difficile infection in a hemodialysis patient: a case report Renal Replacement Therapy Fulminant Clostridioides difficile infection Toxic megacolon Chronic kidney disease Maintenance hemodialysis Polymyxin B-immobilized fiber column direct hemoperfusion |
| title | Rescue of fulminant Clostridioides difficile infection in a hemodialysis patient: a case report |
| title_full | Rescue of fulminant Clostridioides difficile infection in a hemodialysis patient: a case report |
| title_fullStr | Rescue of fulminant Clostridioides difficile infection in a hemodialysis patient: a case report |
| title_full_unstemmed | Rescue of fulminant Clostridioides difficile infection in a hemodialysis patient: a case report |
| title_short | Rescue of fulminant Clostridioides difficile infection in a hemodialysis patient: a case report |
| title_sort | rescue of fulminant clostridioides difficile infection in a hemodialysis patient a case report |
| topic | Fulminant Clostridioides difficile infection Toxic megacolon Chronic kidney disease Maintenance hemodialysis Polymyxin B-immobilized fiber column direct hemoperfusion |
| url | https://doi.org/10.1186/s41100-025-00656-1 |
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