Clostridioides difficile infection diagnosed by nucleic acid amplification test in a patient with Epstein-Barr Virus-related T-cell lymphoproliferative disorder

• Published in: Rinshō ketsueki Vol. 65; no. 8; p. 732
• Main Authors: Seki, Hideshige, Yasunaga, Megumi, Morita, Ken, Kurokawa, Mineo
• Format: Journal Article
• Language: Japanese
• Published: Japan 2024
• Subjects: Adult; Clostridioides difficile; Clostridium Infections - diagnosis; Clostridium Infections - drug therapy; Epstein-Barr Virus Infections - complications; Epstein-Barr Virus Infections - diagnosis; Female; Herpesvirus 4, Human; Humans; Lymphoproliferative Disorders - diagnosis; Lymphoproliferative Disorders - drug therapy; Nucleic Acid Amplification Techniques; T-Lymphocytes; Diarrhea; Clostridioides difficile infection; Nucleic acid amplification test; T-cell post-transplant lymphoproliferative disorder
• ISSN: 0485-1439
• DOI: 10.11406/rinketsu.65.732

Steroid usage poses a risk of Clostridioides difficile infection (CDI), but high-dose corticosteroid treatment can lead to false-negative CD toxin test results. Moreover, CDI-induced nausea can complicate administration of oral antibiotics, which are typically the primary therapy for CDI. In the present case, a 43-year-old woman diagnosed with EBV-associated T-cell post-transplant lymphoproliferative disorder developed CDI during treatment with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP). Following five cycles of CHOP, the patient presented with nausea and diarrhea. CT scans revealed swelling in the ileocecal to transverse area of the colon. While the glutamate dehydrogenase (GDH) antigen test result was positive, the CD toxin test result was negative. However, the nucleic amplification test (NAAT) result was positive, confirming the diagnosis of CDI. Oral treatment with fidaxomicin was initially impractical due to persistent nausea. Instead, treatment began with intravenous metronidazole, and was later switched to fidaxomicin pills. Symptoms improved notably within 10 days, and the patient ultimately made a complete recovery. This case underscores the significance of exploring alternative approaches to CDI management, particularly in immunosuppressed patients.