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©2013 UpToDate ® Print Email Contrast-enhanced computed tomography in 2 1/2-year-old with Clostridium difficile colitis This 2 1/2-year-old boy with an ill-defined congenital arthrogryposis syndrome and developmental delay developed diarrhea. Over a three-week period, his illness progressed to include 6 to 12 stools per day, abdominal tenderness, mild abdominal distension, fever to 39.4°C, and fecal occult blood. The dose of a proton pump inhibitor for gastroesophageal reflux had been increased within two weeks prior to onset, and he had received courses of cefdinir and azithromycin for minor respiratory infections. At admission, polymorphonuclear neutrophil count was 6670/µL, and band count was 14,330/µL. Hemoglobin was 10.5 g. Albumin and globulin were both low at 2.4 g/dL and 2.2 g/dL, respectively. Fecal C. difficile toxin A/B enzyme immunoassay was positive in two successive samples. Computed tomography (above) demonstrated findings consistent with severe C. difficile disease, including colonic wall thickening (panels A, B, C), dilated colon (panel C), and accordion sign (panels A, C). He was admitted to the intensive care unit and treated with oral vancomycin and intravenous metronidazole for two weeks, with clearance of fecal toxin on the second day of treatment and gradual resolution of symptoms. He had two subsequent, progressively milder, toxin-positive relapses, which were treated with tapering courses of vancomycin. Radiographs courtesy of Brian Green, MD, University of Missouri Health Care.