Fecal Microbiota Transplantation as a Rescue Therapy for Refractory Clostridioides difficile Infection in a Patient With Lupus.

Abstract

Clostridioides difficile infection (CDI) remains a major clinical challenge, particularly when it is refractory or recurrent. We describe a 68-year-old woman with systemic lupus erythematosus and other comorbidities who developed fulminant refractory CDI, characterized by ileus and persistent symptoms despite a course of oral vancomycin. She presented with abdominal pain, bilious vomiting, and high-volume diarrhea. Stool testing detected C. difficile toxins A and B, and imaging showed bowel dilatation, mucosal thickening, and lymphadenopathy. Despite 18 days of oral vancomycin and intravenous metronidazole, she showed no clinical improvement. A single fecal microbiota transplantation (FMT) was therefore performed as rescue therapy. Diarrhea resolved completely within 3 days, with no CDI recurrence or FMT-related adverse events during 12 months of follow-up. This case illustrates the potential role of FMT as rescue therapy for fulminant refractory CDI in selected immunocompromised patients. Careful donor screening and close clinical monitoring remain essential, and further research is needed to define the long-term safety of FMT in patients with autoimmune diseases.