22: Clostridioides difficile Infection

PATIENT PRESENTATION

Chief Complaint

Watery diarrhea

History of Present Illness

AH is a 52-year-old Caucasian male with a recent history of hospitalization for cellulitis. He presents to the emergency department with watery diarrhea. He reports approximately 5 unformed stools per day over the last 3 days. He also complains of fever, chills, abdominal cramping, and general fatigue. He states that he was admitted to the hospital 10 days prior for cellulitis of the right knee and was treated with clindamycin. He was discharged, after a 2-day admission, on 5 additional days of clindamycin therapy.

Past Medical History

T2DM, diabetic neuropathy, HTN, HLD, chronic venous stasis, obesity, GERD, cellulitis (resolved)

Family History

Father with T2DM, obesity, and deceased at age 71 secondary to a myocardial infarction. Mother with HTN (living). Sibling with T2DM, HTN (living)

Social History

Tobacco 1/4 ppd × 45 years (quit 8 years prior); 1 (12 oz) beer per day. No illicit drug use

Allergies

Penicillin (swelling of the face)

Home Medications

Metformin 1000 mg PO BID

Glipizide XL 10 mg PO daily

Pregabalin 100 mg PO TID

Lisinopril/HCTZ 20 mg/12.5 mg, 2 tablets PO daily

Amlodipine/atorvastatin 10 mg/80 mg PO daily

ASA 81 mg PO daily

Omeprazole 20 mg PO daily

Clindamycin 450 mg PO QID (recently completed a 7-day course of therapy)

Physical Examination

Vital Signs

Temp 102.7°F, P 88, RR 18 breaths per minute, BP 158/88 mm Hg, pO₂ 94%, Ht 5′10″, Wt 141 kg

General

Mild distress, obese

HEENT

Normocephalic, atraumatic, PERRLA, EOMI, pink/moist mucous membranes and conjunctiva, no headache, no neck stiffness/pain, no photophobia

Pulmonary

CTAB

Cardiovascular

NSR, no m/r/g, DOE

Abdomen

Soft, non-distended, mildly tender to palpation, positive guarding, bowel sounds hyperactive

Genitourinary

Normal male genitalia, no complaints of dysuria or hematuria

Neurology

A&O ×3, cranial nerves intact

Extremities

Normal range of motion, no edema, changes consistent with venous stasis

Emergency Department Labs