title: Clostridium difficile infection--an unusual cause of refractory pouchitis: report of a case.
abstract: OBJECTIVE
  Ileal pouch-anal anastomosis is the surgical procedure of choice for selected patients with severe ulcerative colitis. Pouchitis is a common complication of this procedure, with most cases responding to treatment with metronidazole, possibly with the addition of 5-aminosalicylic acid drugs and steroids. can frequently colonize the colon after treatment with broad-spectrum antibiotics, giving rise to diarrhea or colitis. The aim of this report was to describe the first case of -associated diarrhea manifest as pouchitis.
  
  
  METHODS
  The management of refractory pouchitis in a 35-year-old female with toxin in the stool is described followed by a literature review of small-intestinal infection.
  
  
  RESULTS
  Assays for toxin on stool sent during an episode considered to be caused by idiopathic chronic pouchitis were positive, and treatment with oral vancomycin was initiated. The patient responded with a reduction in bowel frequency to twice daily, a successful discontinuation of her antidiarrheal medication, and a rapid increase in weight. A subsequent stool assay was negative for the toxin.
  
  
  CONCLUSIONS
  infection can complicate pouchitis in patients with an ileal pouch-anal anastomosis and should be considered in patients who fail to respond to standard treatment, including metronidazole. In cases of refractory pouchitis, superadded infection with should be excluded before initiation of potent anti-inflammatory drugs.
authors.affiliation: Department of Medicine, Gastrointestinal Unit, Charing Cross Hospital, London, United Kingdom.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Mann
authors.forename: James
authors.initials: J
authors.lastname: Pitt
authors.forename: Roger G
authors.initials: RG
authors.lastname: Springall
authors.forename: Andrew V
authors.initials: AV
authors.lastname: Thillainayagam
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000150:complications* / Q000188:drug therapy; D039021:Colonic Pouches / Q000382:microbiology*; D005260:Female; D006801:Humans; D007082:Ileum / Q000382:microbiology* / Q000473:pathology; D019449:Pouchitis / Q000188:drug therapy* / Q000382:microbiology*; D016737:Proctocolectomy, Restorative; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin