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Chest Infections |

The Use of Intraveous Immunoglibulin (IVIg) Therapy in a Case of Severe Clostridium difficile (CD) Colitis After Heart Surgery

Nicolas Crescimone, MD; Giri Srikanthan, MD
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University of Miami, Miami, FL


Chest. 2014;145(3_MeetingAbstracts):103A. doi:10.1378/chest.1823566
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Abstract

SESSION TITLE: Infectious Disease Case Reports Posters II

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: An 85 year old male with CAD, severe aortic stenosis, sick sinus syndrome status post pacemaker and CHF, underwent a coronary artery bypass graft and an aortic valve replacement surgery with pericardial valve. He received a preoperative dose of IV vancomycin and cefazolin and 3 postoperative doses of cefazolin as part of the prophylactic protocol. On Hospital Day (HD) #4 he became septic and had several episodes of diarrhea with right lower quadrant abdominal pain.

CASE PRESENTATION: At that time due to the patient’s co-morbidities, hemodynamic instability and refractory nature of the infection, surgical management was not recommended due to the high mortality. One dose of IVIg 200mg/kg was administered. Subsequently WBC decreased to 25,600. A second colonoscopy on HD#15 showed significantly less pseudomembranes with viable mucosa, no ischemia or thinning and no megacolon, trickle feeds were commenced. On HD#25 he had his first bowel movement, which was negative for CD. Subsequently PR Vancomycin was discontinued. On HD#30 due to the persistent bowel distension on Xray, colonoscopy revealed no pseudomembranes, normal appearing mucosa with stools. Post CD Ogilvie Syndorme was diagnosed.

DISCUSSION: At that time due to the patient’s co-morbidities, hemodynamic instability and refractory nature of the infection, surgical management was not recommended due to the high mortality. One dose of IVIg 200mg/kg was administered. Subsequently WBC decreased to 25,600. A second colonoscopy on HD#15 showed significantly less pseudomembranes with viable mucosa, no ischemia or thinning and no megacolon, trickle feeds were commenced. On HD#25 he had his first bowel movement, which was negative for CD. Subsequently PR Vancomycin was discontinued. On HD#30 due to the persistent bowel distension on Xray, colonoscopy revealed no pseudomembranes, normal appearing mucosa with stools. Post CD Ogilvie Syndorme was diagnosed.

CONCLUSIONS: We believe that the institution of IVIG was surgery averting for this patient with significant comorbidities even though it has only been described in case reports.

Reference #1: J Salcedo, S Keates. Intraveous immunoglobilin therapy for severe Clostridium Difficile colitis. Gut 1997; 41: 366-370

DISCLOSURE: The following authors have nothing to disclose: Nicolas Crescimone, Giri Srikanthan

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