Abstract Introduction Clostridium difficile infections originating outside of the gastrointestinal tract are particularly rare. C. Diff infections typically occur in the gastrointestinal tract and clinically manifest with abdominal pain and diarrhea. Extraintestinal manifestations typically show clear origin from within the GI tract and bacterial spread by means of a compromised gut barrier into the blood stream or other organs. Our patient’s clostridium difficile stool toxin, PCR and GDH were negative and the patient showed no signs of gastrointestinal symptoms indicating the GI system as its source. Our patient represents a rare case of a C. diff infection originating outside of the GI tract. Case Report A 49- year old male originally presented with perforated appendicitis. Managed with laparoscopic appendectomy. The patient recovered from the laparoscopic procedure without significant complication until the patient developed severe right sided chest pain, shortness of breath, and a fever. Chest imagining showed the development of a large right pleural effusion. During this time his abdominal exam remained benign. A chest tube was placed for drainage and pleural fluid sent for analysis. The patient’s pleural fluid culture was found positive for Clostridium difficile. While he did not exhibit any gastrointestinal symptoms, c difficile stool studies were obtained. GDH, PCR and C. diff toxin analysis of these stool collections remained negative strongly suggesting extraintestinal origination. Discussion Our case presents two important questions. How can a clostridium difficile infection originate from outside of the gastrointestinal tract and, more importantly, what is the best way to treat such an extraintestinal manifestation. There are no guidelines on how to treat a C. diff infection in the pleural space inpatient. Additionally, there are no guidelines on outpatient treatment of C. diff pleural effusions. This patient’s case required multidisciplinary critical thinking in order to determine the best course of treatment. Moreover, this unique case will remind fellow physicians of keeping a broad differential in their suspected organism. This abstract is funded by: None
Abdullah et al. (Fri,) studied this question.