title: Clostridium difficile colitis associated with hemolytic-uremic syndrome.
abstract: The authors report the case of a 46-year-old woman who presented with vomiting and profuse bloody diarrhea. Laboratory studies were significant for a hematocrit of 27% and lactate dehydrogenase of 5,394 U/L (5,394 U/L). Her renal function deteriorated rapidly with a peak creatinine of 12.4 mg/dL (1,096.4 micromol/L), and platelet count dropped simultaneously to a nadir of 123,000/microL (123 x 10(9)/L]. Schistocytes were observed in peripheral blood smear. Stool was positive for Clostridium difficile toxin A by enzyme immunoassay (EIA). Stool assay for Shiga-like toxin was negative by EIA, and stool cultures returned negative for Escherichia coli O157:H7 and other enteric pathogens. A diagnosis of C difficile colitis associated with hemolytic-uremic syndrome was made; the patient received plasmapheresis and recovered with no relapse after 10 months of follow-up. This is the second reported case of C difficile colitis associated with hemolytic-uremic syndrome in an adult.
authors.affiliation: Division of Infectious Diseases, George Washington University Medical Center, Washington, DC 20037, USA.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Mbonu
authors.forename: Danielle L
authors.initials: DL
authors.lastname: Davison
authors.forename: Khaled M
authors.initials: KM
authors.lastname: El-Jazzar
authors.forename: Gary L
authors.initials: GL
authors.lastname: Simon
mesh_terms: D016360:Clostridioides difficile / Q000302:isolation & purification; D004761:Enterocolitis, Pseudomembranous / Q000150:complications*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000821:virology*; D006801:Humans; D008875:Middle Aged