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Fecal Transplant for Treatment of Toxic Megacolon Associated With Clostridium Difficile Colitis in a Patient With Duchenne Muscular Dystrophy

Yu, Shipeng MD, PhD; Abdelkarim, Ahmed MD; Nawras, Ali MD; Hinch, Bryan Thomas MD; Mbaso, Chimaka MD; Valavoor, Shahul MD; Safi, Fadi MD; Hammersley, Jeffrey MD; Tang, Jianlin MD; Assaly, Ragheb MD

doi: 10.1097/MJT.0000000000000062
Case Reports
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Clostridium difficile (C diff) colitis infection is the most common cause of nosocomial infectious diarrhea and the prevalence is increasing worldwide. Toxic megacolon is a severe complication of C diff colitis associated with high mortality. Gastrointestinal (GI) comorbidity and impaired smooth muscle contraction are risk factors for the development of C diff-associated toxic megacolon. We present a case of fulminant C diff colitis with toxic megacolon in a patient with Duchenne muscular dystrophy (DMD) in the intensive care unit. C diff colitis was diagnosed by clinical presentation and positive C diff DNA amplification test (polymerase chain reaction). The impairment of GI tract due to DMD predisposes these patients to severe C diff infection and toxic megacolon, as observed in this case report. For the same reason, the recovery of GI function in these patients can be prolonged. While surgery was conducted for relieving the pressure from toxic megacolon, fecal microbiota transplantation through colonoscopy resulted in successful resolution of the C diff symptoms, although the recovery is prolonged due to DMD.

1Departments of Internal Medicine,

2Gastroenterology,

3Pulmonary and Critical Care, and

4General Surgery, University of Toledo Medical Center, Toledo, OH.

Address for correspondence: Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, MS 1186, Toledo, OH 43614. E-mail: shipeng.yu@utoledo.edu

The authors have no conflicts of interest to declare.

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