Fatal Clostridium difficile-associated toxic megacolon following unrelated stem-cell transplantation

Background: Nosocomial Clostridium difficile- associated colitis occurs in 1-4% of surgical patients. In 3-5%, it may progress to toxic megacolon (TM) and severe sepsis, requiring surgical intervention. Methods: Case report. Results: A patient suffering from neutropenia following peripheral blood stem-cell transplantation for acute lymphatic leucemia developed TM despite therapy with Metronidazol and oral Vancomycin. Ultimately she underwent right sided and subsequently subtotal colectomy. After successful treatment of TM the patient died later from multiorgan failure in the course of prolonged neutropenia. Conclusions: Patients with expected prolonged neutropenia who develop toxic megacolon should undergo subtotal colectomy without delay as they seem not to be able to control the infection even when receiving appropriate antibiotic therapy.