Fatal community-acquired ribotype 002 Clostridium difficile bacteremia

Extra-colonic infections, and especially bacteremia, are infrequent manifestations of Clostridium difficile infection. C. difficile bacteremia is generally health-care associated and polymicrobial. We report the case of a patient on hunger strike that presented a C. difficile colitis and mono-microbial bacteremia on its admission to the hospital. Multilocus variable number tandem repeat analysis of stool and blood isolates indicated clonality. The strain was characterized as a ribotype 002, an emerging ribotype previously associated with high fatality rate. The patient received treatment by intra-venous amoxicillin-clavulanate and oral vancomycin but eventually died on the seventh day of admission with concomitant pneumonia and pulmonary embolism. •Clostridium difficile bacteremia is uncommon and usually health-care associated.•We report a case of fatal community-acquired CDB associated with a C. difficile colitis in a patient on hunger strike.•Multilocus variable number tandem repeat analysis of stool and blood isolates indicated clonality.•The strain belonged to ribotype 002 which is an emerging cause of severe and health-care associated C. difficile infections.•We hypothesize that severe malnutrition lead to dysbiosis and impaired mucosal immunity promoting translocation from the gut.