Atypical presentation of Clostridium difficile colitis in patients with cystic fibrosis

OBJECTIVE. This report describes the unusual presentation of Clostridium di fficile colitis in five patients with cystic fibrosis and the role of CT in first suggesting the correct diagnosis in this group of patients. Because of the absence of watery diarrhea and the presence of abdominal bloating an d decreased stooling, cystic fibrosis patients with C. difficile colitis wi ll be treated for stool impaction, meconium ileus equivalent, or distal int estinal obstruction syndrome. CT of the abdomen, performed in these five pa tients because of their lack of improvement after standard therapy for stoo l impaction, showed an extensive pancolitis later confirmed to be caused by C. difficile infection. CONCLUSION. In patients with cystic fibrosis, imaging findings of a pancoli tis should raise the possibility of C. difficile colitis despite the lack o f watery diarrhea. Anticlostridial treatment can be initiated before bacter iologic confirmation is obtained.