Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2019; 7(17): 2597-2604
Published online Sep 6, 2019. doi: 10.12998/wjcc.v7.i17.2597
Fecal microbiota transplantation as an effective initial therapy for pancreatitis complicated with severe Clostridium difficile infection: A case report
Yang Hu, Hai-Ying Xiao, Cong He, Nong-Hua Lv, Liang Zhu
Yang Hu, Hai-Ying Xiao, Cong He, Nong-Hua Lv, Liang Zhu, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Xiao HY and Hu Y searched for similar published cases, analyzed the data, and wrote the manuscript; Xiao HY collected the patient’s clinical data; Zhu L designed the study; He C performed the fecal microbiota transplantation procedure; He C and Lv NH provided the materials for the study and participated in writing the paper; all authors issued final approval for the version to be submitted.
Supported by Project of Postgraduate Teaching Case Base Construction of Nanchang University, No. 9202-0210210802; Project of Health Commission of Jiangxi Province, No. 20175071; Postgraduate Innovation Fund Project of Nanchang University, No. 2017262.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Liang Zhu, MD, PhD, Academic Fellow, Attending Doctor, Doctor, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Street, Nanchang 330006, Jiangxi Province, China.
Telephone: +86-791-88694228 Fax: +86-791-88694228
Received: April 9, 2019
Peer-review started: April 10, 2019
First decision: May 9, 2019
Revised: July 2, 2019
Accepted: July 20, 2019
Article in press: July 20,2019
Published online: September 6, 2019

Moderately severe acute pancreatitis (MSAP) is a critical form of acute pancreatitis that is related with high morbidity and mortality. Severe Clostridium difficile infection (sCDI) is a serious and rare nosocomial diarrheal complication, especially in MSAP patients. Fecal microbiota transplantation (FMT) is a highly effective treatment for refractory and recurrent CDI (rCDI). However, knowledge regarding the initial use of FMT in patients suffering from sCDI is limited.


Here, we report an MSAP patient complicated with sCDI who was treated by FMT as a first-line therapy. The patient was a 51-year-old man who suffered from diarrhea in his course of acute pancreatitis. An enzyme immunoassay was performed to detect toxins, and the result was positive for toxin-producing C. difficile and toxin B and negative for C. difficile ribotype 027. The colonoscopy revealed pseudomembranous colitis. Due to these findings, sCDI was our primary consideration. Because the patient provided informed consent for FMT treatment, we initially treated the patient by FMT rather than metronidazole. Diarrhea resolved within 5 d after FMT. The patient remained asymptomatic, and the follow-up colonoscopy performed 40 d after discharge showed a complete recovery. Our case is the first reported in China.


This case explores the possibilities of initially using FMT to treat severe CDI. Moreover, FMT may become a critical component of the treatment for severe CDI in MSAP patients.

Keywords: Acute pancreatitis, Clostridium difficile infection, Fecal microbiota transplantation, Pseudomembranous colitis, Initial therapy, Case report

Core tip: A rare complication of acute pancreatitis is Clostridium difficile infection (CDI). Certain antibiotics are used as the treatment of choice for CDI. However, in our case, fecal microbiota transplantation (FMT) was considered the best treatment and achieved good results. This case demonstrates that FMT can be considered a first-line treatment for primary severe CDI in moderately severe acute pancreatitis patients.