Book review

https://doi.org/10.20471/acc.2025.64.02.23

Concurrent Clostridium difficile colitis and Cytomegalovirus Infection as a Cause of Persistent Diarrhea after Autologous Hematopoietic Stem Cell Transplantation for Non-Hodgkin Lymphoma Following Bendamustine-Based Conditioning

Martina Sedinić Lacko ; Division of Hematology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia
Zdravko Mitrović ; Division of Hematology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia *
Sandra Šestan Crnek ; Center for Clinical Microbiology and Hospital Infections, Dubrava University Hospital, Zagreb, Croatia
Ozren Jakšić ; Division of Hematology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
Željko Prka ; Division of Hematology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia
Vlatko Pejša ; Division of Hematology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia

* Corresponding author.

Abstract

Diarrhea usually appears early following autologous hematopoietic stem cell transplantation
(ASCT) due to toxic mucosal damage and neutropenia. Infectious agents also cause diarrhea
in the post-transplantation period, with Clostridium difficile (C. difficile) being most common. In contrast,
cytomegalovirus (CMV) enterocolitis is extremely rare after ASCT. We report a case of a 55-year-old
male who underwent ASCT for non-Hodgkin lymphoma that was complicated by severe persistent
diarrhea resulting in significant hypovolemia and electrolyte imbalance. Prior to transplantation, the
patient received rituximab in combination with chemotherapy (R-CHOP/R-DHAP) followed by a
bendamustine-based conditioning regimen (BeEAM). After treatment with oral metronidazole, vancomycin
and fidaxomicin, diarrhea persisted despite undetectable C. difficile toxin, with elevation of hepatic
enzymes. Eventually, CMV infection was diagnosed by real-time polymerase chain reaction and treated
with ganciclovir and valganciclovir. Due to hypogammaglobulinemia following previous rituximab
treatment, CMV immunoglobulins were also administered. The patient’s condition gradually improved
with CMV DNA being undetectable in serum. This case shows that diarrhea may be caused by concurrent
infection with C. difficile and CMV after ASCT. Bendamustine-induced colitis and prior rituximab
treatment may have been additional risk factors in this patient. Therefore, more comprehensive workup
of diarrhea is needed in ASCT recipients treated with these agents.

Keywords

Autologous hematopoietic stem cell transplantation; Cytomegalovirus; Clostridium difficile; Colitis; Bendamustine; Rituximab

Hrčak ID:

337962

URI

https://hrcak.srce.hr/337962

Publication date:

30.6.2025.

Article data in other languages: croatian

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