Pseudomembranous Colitis Associated with Clostridium difficile

A 75-year-old man with peripheral vascular disease, chronic obstructive pulmonary disease, and diabetes mellitus presented with gangrene of the right fourth toe and underwent tarsal–metatarsal amputation to manage the progression of gangrene, followed by amputation of the right leg below the knee. His hospital course was complicated by a myocardial infarction and pneumonia. During hospitalization, he was treated with multiple antimicrobial agents, including imipenem, vancomycin, piperacillin, tazobactam, and gatifloxacin. During the sixth week of hospitalization, abdominal pain, nausea, diarrhea, fever, and leukocytosis characterized by 48,000 leukocytes per microliter developed. A stool culture and toxin screen were both positive for Clostridium . . .