Treatment of the First Severe Attack of Pseudomembranous Colitis with Fecal Microbiota Transplantation

Our patient was a 30 year-old female, who was a diagnosed case of tubercular meningitis (TBM) and was on antitubercular treatment (ATT) for 5 days before she came to us. She was being investigated for fever with headache before being diagnosed as TBM 30 days prior to her presentation and had received multiple oral antibiotics on outpatient basis. She had also been admitted in two different hospitals and received intravenous (IV) antibiotics during that period. She presented with complaints of passage of loose stools 7 to 8 times per day for the last 5 days.The stools were watery in nature and associated with abdominal distension and pain for 3 days, bilateral pedal edema for 3 days and breathlessness for 2 days before admission to this hospital. She was diagnosed with Clostridium difficile (C. difficile) pseudomembranous colitis following a sigmoidoscopy (Figure 1) and a positive stool test for C. difficile toxin. She had an initial leukocyte count of 21360/mm3 with a serum albumin level of 1.3 g/dl and a serum creatinine level of 0.6 mg/dl, thus classifying her as having severe C. difficile colitis. She was started on IV metronidazole and oral vancomycin which was uptitrated to 500 mg every six hours. She continued to have diarrhea even despite 3 days of treatment. She was started on the higher antibiotic, IV Tigecycline, but continued to have abdominal distension and pain, suggesting refractory CDI.1,2 Repeat sigmoidoscopy showed the same picture as earlier without any improvement. Given the severity and refractoriness to the standard antibiotics, a decision to perform fecal microbial transplantation (FMT) was taken on day 6.