Infliximab use in ulcerative colitis flare with clostridium difficile infection: A report of two cases and literature review

Abstract

Clostridium difficile infection (CDI) is a major cause of morbidity and mortality in patients with inflammatory bowel disease(IBD), especially in ulcerative colitis (UC). The incidence and severity of CDI in IBD has shown an increasing trend in the lasttwo decades. Patients with IBD are predisposed to CDI secondary to the recurrent use of antibiotics, corticosteroids, andimmunosuppressants and secondary to dysbiosis. It is clinically challenging to distinguish the symptoms of CDI from an IBDflare. The worsening of IBD symptoms demands escalation of steroids or initiation of biologics. However, the managementof CDI in IBD, not responding to antibiotics, is not well described beyond a few case reports. We report two cases of CDIwith active UC flare. The patients did not respond to antibiotics or intravenous corticosteroids but had rapid resolution of CDIsymptoms after receiving infliximab infusion. The optimal dosing and infusion frequency of infliximab in management of CDIin UC/IBD remains to be established.