Severe Ileocolonic Crohn's Disease Flare Associated with Fecal Microbiota Transplantation Requiring Diverting Ileostomy
Vivy Tran, MD, Jennifer Phan, MD, Benjamin Nulsen, MD, et al
ACG Case Rep J. 2018;5:e97.
Editor’s Commentary: This month’s case
describes the course of a patient with Crohn’s disease complicated by recurrent
Clostridium difficile infection (CDI).
Given the increased risk of CDI in patients with inflammatory bowel disease (IBD), this clinical scenario is common and the case highlights a cautionary tale related to the use of fecal microbiota transplantation (FMT) in this population. The authors describe the use of FMT as a possible recurrence prevention strategy after resolution of the 7th episode of CDI in a patient with Crohn's disease on ustekimumab. The patient subsequently developed a severe flare of his disease, requiring diverting ileostomy after failure of steroids before eventually improving. While studies regarding the utility of FMT in both recurrent CDI and for underlying IBD itself are ongoing, increasing the awareness of providers on the potential risks is critical when ensuring that patients are fully counseled as to the possible outcomes.