title: Atypical Presentation of C. Difficile Infection: Report of a Case with Literature Review.
abstract: Clostridium difficile (C. difficile) is a gram-positive, obligate, anaerobic spore-forming bacillus first reported by Hall and O'Toole in 1935. It occurs mostly after antibiotic use and invariably presents with watery diarrhea. We describe an atypical presentation of C. difficile in a 64-year-old Caucasian female who presented to the our emergency department with abdominal pain, nausea, and vomiting for one day. A complete blood count revealed leukocytosis 30 x 10(9)/L and a subsequent computed tomography (CT) scan of the abdomen and the pelvis, showed fluid filled small bowel loops consistent with enteritis. Her presentation was unusual for lack of diarrhea, the hallmark of C. difficile infection. She was admitted and treated with oral vancomycin. The polymerase chain reaction (PCR) value in the stool for C. difficile was positive. The patient responded very well: her abdominal pain resolved and leukocyte count normalized after a few doses of vancomycin (125 mg po qid). The patient's progress was followed in our clinic for the last three months.
authors.affiliation: Department of Internal Medicine, University of Missouri-Kansas City.
authors.forename: Salman A
authors.initials: SA
authors.lastname: Khan
authors.affiliation: Department of Medicine, School of Medicine, University of Missouri-Kansas City.
authors.forename: Arooge
authors.initials: A
authors.lastname: Towheed
authors.affiliation: Department of Medicine, School of Medicine, University of Missouri-Kansas City.
authors.forename: Sibghat
authors.initials: S
authors.lastname: Tul Llah
authors.affiliation: Department of Medicine, School of Medicine, University of Missouri-Kansas City.
authors.forename: Aref
authors.initials: A
authors.lastname: Bin Abdulhak
authors.affiliation: Department of Internal Medicine, University of Missouri-Kansas City.
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Tilson-Mallett
authors.affiliation: Department of Internal Medicine, University of Missouri-Kansas City.
authors.forename: Alan
authors.initials: A
authors.lastname: Salkind
keywords: c.difficile enteritis; lack of diarrhea; leukocytosis