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Logo of bmjcrInstructions for authorsCurrent ToCBMJ Case Reports
BMJ Case Rep. 2010; 2010: bcr06.2009.2017.
Published online Jan 13, 2010. doi:  10.1136/bcr.06.2009.2017
PMCID: PMC3029095
Unusual presentation of more common disease/injury
Toxic megacolon from hypervirulent Clostridium difficile infection (ribotype 027) following elective total knee replacement: an emerging challenge in modern health care
Buchi Rajendra Babu Arumilli,1 Prasanthi Koneru,2 and Irfan Fayyaz1
1Manchester Royal Infirmary, Trauma & Orthopaedics, Oxford Road, Manchester M13 9WL, UK
2Halton Primary Care Trust, Community Paediatrics, Lister Road, Runcorn WA7 1TW, UK
Correspondence to Buchi Rajendra Babu Arumilli, rajjuorth/at/
We present a rare case of community acquired (presenting in hospital on the day of admission or within 48 h of admission) Clostridium difficile infection (CDI) with the hypervirulent (ribotype 027) strain causing toxic megacolon in a patient, diagnosed on the third postoperative day following an elective total knee replacement. The patient did not have any of the commonly reported risk factors for CDI. The source of sepsis was initially presumed to be the operated prosthetic joint, and this caused a delay in the correct diagnosis and institution of appropriate antimicrobial treatment which may have contributed to a poorer outcome. This case highlights the risk of patients arriving from the community manifesting life threatening CDI in the hospital.
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