Efficacy of fidaxomicin therapy, after failure of vancomycin therapy, for treating a C. difficile colitis in a patient with ulcerative colitis

Patients with inflammatory bowel diseases (IBDs) have greater risk of developing C. difficile infection (CDI). In these patients, CDI have worse outcome, may be associated with increased risk of bacteremia and candidemia and may be misdiagnosed as relapse of IBD, also because of the absence of typical findings of CDI at colonoscopy. A 58-year-old man with acute ulcerative colitis treated with steroids was hospitalized for fever and recrudescence of inflammatory diarrhea. During the hospitalization, the fever was treated with broad spectrum antibiotics and systemic anti-fungal therapy. Candida mannan antigen and the molecular screening for C. difficile resulted positive. A first course of vancomycin by mouth was unsuccessful, therefore we started a 10-day course of fidaxomicin. After five days of therapy, diarrhea disappeared. A few-week course of fluconazole therapy was performed to complete the treatment of invasive candidiasis. At six-month follow-up no relapse of CDI was documented.