Fulminant Clostridium difficile colitis associated with paclitaxel and carboplatin chemotherapy

Pseudomembranous colitis is commonly associated with the use of antibiotics . Some antineoplastic agents even without associated antibiotic use can pre dispose patients to developing infection with Clostridium difficile. The in fection is usually mild; however, in rare cases severe forms of pseudomembr anous colitis may be encountered. A 66 year-old female with stage IIIC subo ptimally debulked epithelial ovarian cancer was treated with paclitaxel and carboplatin. the patient developed fulminant C. difficile colitis three we eks after the second cycle of chemotherapy. Severe symptoms began 24 h prio r to admission; however, mild nausea and diarrhea had been present for a we ek despite self-treatment with over-the-counter Imodium and Pepto-Bismol. H er last antibiotic use was seven weeks previously. The patient was hospital ized immediately for aggressive treatment. Notwithstanding all the efforts, her condition continued to deteriorate and she expired. Severe C. difficil e colitis can be life threatening. Patients undergoing chemotherapy who dev elop significant diarrhea should be evaluated for C. difficile. Prompt diag nosis and intervention prior to onset of severe symptoms can potentially im prove the outcome.