Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2015; 21(12): 3736-3740
Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3736
Complicated fecal microbiota transplantation in a tetraplegic patient with severe Clostridium difficile infection
Thorsten Brechmann, Justyna Swol, Veronika Knop-Hammad, Jörg Willert, Mirko Aach, Oliver Cruciger, Wolff Schmiegel, Thomas A Schildhauer, Uwe Hamsen
Thorsten Brechmann, Wolff Schmiegel, Jörg Willert, Department of Gastroenterology and Hepatology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, 44789 Bochum, Germany
Justyna Swol, Thomas A Schildhauer, Uwe Hamsen, Department of General and Trauma Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, 44789 Bochum, Germany
Veronika Knop-Hammad, Institute of Laboratory Medicine, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, 44789 Bochum, Germany
Mirko Aach, Oliver Cruciger, Department of Neurotraumatology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, 44789 Bochum, Germany
Author contributions: Brechmann T, Swol J, Knop-Hammad V, Willert J, Aach M, Cruciger O, Schmiegel W, Schildhauer TA and Hamsen U were involved in the treatment of the patient; Brechmann T, Hamsen U, Knop-Hammad V and Cruciger O prepared and revised the manuscript; Swol J, Willert J, Aach M, Schmiegel W and Schildhauer TA revised the manuscript.
Ethics approval: This retrospective case report has not been discussed with the institutional review board.
Informed consent: The manuscript has been prepared anonymously with informed consent of the patient and his son.
Conflict-of-interest: The authors declare they have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Thorsten Brechmann, MD, Department of Gastroenterology and Hepatology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany. thorsten.brechmann@rub.de
Telephone: +49-234-3023411 Fax: +49-234-3026707
Received: August 25, 2014
Peer-review started: August 25, 2014
First decision: October 29, 2014
Revised: December 4, 2014
Accepted: January 16, 2015
Article in press: January 16, 2015
Published online: March 28, 2015
Processing time: 217 Days and 12.3 Hours
Abstract

A 65-year-old male suffering from acute spinal cord injury leading to incomplete tetraplegia presented with severe recurrent Clostridium difficile (C. difficile) infection subsequent to antibiotic treatment for pneumonia. After a history of ineffective antimicrobial therapies, including metronidazole, vancomycin, fidaxomicin, rifaximin and tigecycline, leading to several relapses, the patient underwent colonoscopic fecal microbiota transplantation from his healthy son. Four days subsequent to the procedure, the patient showed a systemic inflammation response syndrome. Without detecting an infectious cause, the patient received antimicrobial treatment, including tigecycline, metronidazole, vancomycin via polyethylene glycol and an additional enema for a period of seven days, leading to a prompt recovery and no reported C. difficile infection relapse during a 12 wk follow up.

Keywords: Clostridium difficile infection; Spinal cord injury; Fecal microbiota transplantation; Systemic inflammatory response syndrome

Core tip: A 65-year-old male suffering from incomplete tetraplegia presented with severe recurrent Clostridium difficile (C. difficile) infection subsequent to antibiotic treatment of pneumonia. After several antimicrobial therapies with subsequent relapses, the patient underwent colonoscopic fecal microbiota transplantation from his healthy son. Four days later, the patient showed a systemic inflammation response syndrome. Without detecting an infectious cause, the patient received antimicrobial treatment, including tigecycline, metronidazole, vancomycin via polyethylene glycol and an additional enema, for a period of seven days, leading to prompt recovery and no reported C. difficile infection relapse during a 12 wk follow up.