In that particular instance, the patient had undergone appendectomy following the development of perforating inflammation due to acute appendicitis. Most of the CDI cases were associated with pseudomembranous colitis, except 1 that was accompanied by reactive arthritis. To the best of our knowledge, our patient was the first case of C. We think that our patient's exposure to risk factors made him vulnerable to CDIs. The risk factors for CDI include the use of antibiotics, presence of chronic lung disease or ileus, prolonged stay at an intensive care unit, history of surgery, and a long-term stay at a care facility. There are a few cases of extracolonic CDI, the manifestations of which include bacteremia, osteomyelitis, visceral abscess, empyema, reactive arthritis, and small bowel disease. difficile is rarely found at sites outside the bowel. He was discharged with no hope for recovery, and we were unable to investigate the C. Subsequently, the patient's general condition worsened, and his family wished to have him close to home. A Clostridium toxin assay was performed for a stool specimen by using the VIDAS system (bioMerieux), and the results was negative. The sequence thus obtained (1,466 bp) was compared with published sequences in the Gen-Bank database by using the basic local alignment search tool (BLAST)n algorithm ( and the isolate showed 99.05% similarity to C. The presence of these microorganisms was further confirmed with commercial 16S rRNA gene sequencing (Macrogen, Seoul, Korea), for which 2 primers were used: 518F (5'-CCAGCAGCCGCGGTAATACG-3') and 800R (5'-TACCAGGGTATCTAATCC-3'). difficile by using the VITEK 2 system (bioMerieux, Marcy-I'Etoil, France), with 99% probability. Subsequently, blood culture on HD 163 showed the absence of pathogens in the patient's blood.īlood cultures on HD 186 revealed the presence of anaerobic gram-positive bacilli, which were subcultured on blood agar and incubated anaerobically. On HD 157, the patient's blood culture showed the presence of Enterococcus faecium, and the patient was again treated with meropenem. On HD 146, the patient showed hematochezia through the site of ileostomy. As a result, the antibiotic therapy was changed to piperacillin/metronidazole. On HD 141, the fever recurred and blood culture revealed the presence of Escherichia coli. On HD 113, loop ileostomy was performed, and antibiotic therapy involving ticarcillin was initiated. On hospitalization day (HD) 98, the patient developed fever, and antibiotic therapy with vancomycin/meropenem was initiated. Consequently, the patient underwent nephrostomy in the pelvic region in conjunction with insertion of a stent in the colon.
External compression of the rectum due to metastasis was suspected as the cause of rectal stricture.
The cancer recurred after 2 yr and eventually metastasized to multiple sites, causing hydronephrosis, obstructive acute kidney injury, and rectal stricture. A 60-yr-old Korean man had been diagnosed with prostate cancer 4 yr ago and was followed up after chemotherapy.