S5077 Atypical Case of Clostridioides difficile Enteritis in a Healthy Adult: Mimicking Crohn’s Disease

Introduction: Clostridioides difficile enteritis is a very rare extra-colonic manifestation of Clostridioides difficile infection, with less than 100 case reports in the literature. While typically cases have risk factors like prior antibiotic use or surgery or immunosuppression, presentations in immunocompetent individuals without these risk factors are a diagnostic challenge. Case Description/Methods: A 50-year-old man with a past medical history of 15 years of irritable bowel syndrome, no past surgical history, and no recent antibiotic exposure presented with 2 days of severe abdominal pain, nausea, vomiting, and watery diarrhea. He reported intermittent non-bloody diarrhea for years; however, this episode was more severe. No fever, recent travel, or sick contacts. Family history was significant for Crohn’s disease. On physical examination, he had diffuse abdominal tenderness with no rigidity or guarding. Computed tomography (CT) abdomen/pelvis with intravenous contrast showed diffuse small bowel dilation and mural thickening suggestive of enteritis or early small bowel obstruction. Vitals and lab values were not significant, with a normal white blood cell count. Given his clinical picture and imaging findings of enteritis, a new diagnosis of Crohn’s disease was suspected, and corticosteroids were initiated. However, stool polymerase chain reaction for Clostridioides difficile returned positive. Steroids were promptly discontinued, the patient was started on oral vancomycin, and he improved clinically within 2 days. An interval CT abdomen/pelvis showed resolution of small bowel mucosal inflammation and distension. Discussion: This case highlights an atypical presentation of Clostridioides difficile enteritis in a healthy adult without typical risk factors. Such cases can be easily mistaken for Crohn’s disease. The initial diagnostic challenge led to inappropriate immunosuppression with steroids. Early discontinuation of corticosteroids helped improve treatment outcomes. This case highlights the importance of considering Clostridioides difficile infection even in a relatively healthy adult with enteritis, even in immunocompetent hosts without prior antibiotic exposure. Awareness of this rare extra-colonic manifestation of Clostridioides difficile infection is crucial, as delayed diagnosis or immunosuppression can lead to worse outcomes.