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C. difficile fulminant colitis — ABEM Board MCQ

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HardGI/Abdominal emergenciesC. difficile fulminant colitisABEM Board

A 72-year-old woman arrives with profuse diarrhea after clindamycin. Triage acuity is ESI 2; T 102.2 F, BP 86/48 mm Hg, HR 128/min. Abdomen is distended and tender, WBC is 34,000/microL, and creatinine has doubled. CT shows colitis without perforation. Which of the following is the most appropriate next step in management?

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Correct answer: A — Start oral vancomycin plus IV metronidazole and obtain surgical consultation

Fulminant C. difficile with shock or ileus requires high-dose enteral vancomycin, IV metronidazole, resuscitation, and early surgical involvement.

Reference: IDSA/SHEA C. difficile guideline