Faecal microbiota transplantation as a non-standard therapy for the treatment of Clostridioides difficile in an ulcerative colitis patient

We report a case of the 67-year-old female patient with ulcerative colitis (UC), who was admitted to the Department of Digestive Tract Diseases in Norbert Barlicki Memorial University Hospital, Lodz for microbiota transplantation due to Clostridioides difficile infection (CDI) not responding to vancomycin treatment. Since 28 December 2020 she had been reporting abdominal pain, nausea, vomiting, and diarrhoea with mucus and blood (17–18 times/day). Additionally, the patient lost 5 kg during 3 weeks. Laboratory parameters showed elevated markers of inflammation: C-reactive protein (CRP) 108.00 mg/l (0–5), OB 52 mm/h (0–30), and iron deficiency: Fe 15.3 µg/dl (60–145). On 12 January 2021 the patient was admitted to the Regional Hospital in Konin for colonoscopy due to persisting symptoms. Until that time the patient had not been diagnosed with any gastrointestinal disease. Before examination, a SARS-CoV-2 RT-PCR test was performed, and the result was positive. Therefore, the colonoscopy was delayed, and on 14 January the patient was admitted to the COVID-19-appointed hospital ward in Słupca. During hospitalization the patient was treated with mesalazine, hydrocortisone, mebeverine, and pantoprazole. On 21 January she was transferred to another COVID-19-appointed hospital in Poznan for further diagnostics, where she stayed until 9 February. The patient was treated for COVID-19 with the following: ceftriaxone, enoxaparin, and dexamethasone sodium phosphate. A colonoscopy showed inflammatory lesions in the rectal colon segment and pseudopolyps in the rectum, sigmoid colon, and descending colon. In addition, there were ulcerations of mucosa in the rectum, sigmoid colon, and descending colon. A histopathological examination confirmed ulcerative colitis. There was also mild epithelial dysplasia. In the section from the sigmoid colon and rectum, active foci with inflammatory granulation tissue were confirmed. The material did not include the glandular epithelium. The patient was treated with prednisone and mesalazine.
On 12 February 2021 (to 25 February), she was re-hospitalized in the Department of Gastroenterology at the Poznan University of Medical Science in Poznan due to persistent symptoms. In colonoscopy the mucosa of the entire colon was swollen, brittle, and bleeding in the contact with ulceration. The rectal mucosa was red and swollen with yellowish white plaques. The whole picture indicated CDI, and so metronidazole treatment was introduced....


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