Сl. difficile-associated enterocolitis in child with atopic dermatitis and cow's milk protein allergy: clinical case

The article presents the clinical case of severe Cl. difficile-associated diarrhea in a three-year-old child suffering from atopic dermatitis and cow’s milk protein allergy. Clinical manifestations of the disease included fever, bloody diarrhea, and abdominal pain. Diagnosis was established based on medical history, clinical presentation, negative results from ELISA, PCR, and microbiological stool tests for viral and bacterial pathogens causing intestinal infections, along with a positive stool test for toxins A and B produced by Cl. difficile, confirmed by prompt improvement after initiation of vancomycin therapy. Within three days of the child being discharged from the hospital, symptoms of hemorrhagic colitis recurred. Upon readmission, stool testing for toxins A and B of Cl. difficile yielded negative results; however, given the clinical and epidemiological context, including the potential for false negatives, antibacterial therapy with vancomycin was initiated again. Treatment resulted in complete resolution of symptoms and normalization of the child’s general condition. Over the next year of follow-up, there were no signs of gastrointestinal injury or recurrence, suggesting successful treatment and recovery of normal bowel function. Analysis of this case highlighted challenges in diagnosing and managing Cl. difficile infection, which could be addressed by implementing the following strategies: when initial screening for toxins A and B of Cl. difficile in fecal specimens produces negative results via enzyme-linked immunosorbent assays (ELISAs), additional testing utilizing more reliable methods such as toxicigenic culture isolation should proceed. This involves adopting multistep diagnostic algorithms as suggested by current guidelines. Additionally, treatment approaches must be tailored individually, accounting for all relevant risk factors and specifics of each patient’s health profile.

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