Fulminant clostridioides difficile infection complicated with septic shock in a patient after rectal adenocarcinoma surgery and chemotherapy: a case report

Background Clostridioides difficile is the predominant pathogenic bacterium responsible for antibiotic-associated diarrhea. Fulminant Clostridioides difficile infection (CDI) is linked to significant morbidity and mortality, representing an urgent and serious clinical situation. Presentation of the case: We present a case of a 72-year-old patient with rectal cancer who experienced fulminant CDI following rectal adenocarcinoma surgery and chemotherapy. The clinical signs comprised intense pyrexia, diarrhea, bloating and respiratory failure. Furthermore, the patient was complicated with pulmonary infection and intra-abdominal infection secondary to an anastomotic leak. Vancomycin (500 mg) was administered orally every 6 hours (q6h) in combination with metronidazole (500 mg) via intravenous infusion every 8 hours (q8h) for the patient, and the course of treatment was appropriately prolonged. Besides, concomitant administration of other antibiotics was initiated during anti-Clostridioides difficile therapy. The patient ultimately recuperated and was discharged from the hospital. Conclusions Our case demonstrates the efficacy of vancomycin (500 mg q6h) in combination with metronidazole (500 mg q8h) in the treatment of fulminant CDI. When additional antibiotics are required for concurrent infection, the types and dosages of the antibiotics should be taken into consideration and the course of treatment for CDI should be appropriately prolonged.