• Nicolas Crescimone and Giri Srikanthan.
• Chest. 2014 Mar 1;145(3 Suppl):103A.

Session TitleInfectious Disease Case Reports Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: An 85 year old male with CAD, severe aortic stenosis, sick sinus syndrome status post pacemaker and CHF, underwent a coronary artery bypass graft and an aortic valve replacement surgery with pericardial valve. He received a preoperative dose of IV vancomycin and cefazolin and 3 postoperative doses of cefazolin as part of the prophylactic protocol. On Hospital Day (HD) #4 he became septic and had several episodes of diarrhea with right lower quadrant abdominal pain.Case PresentationAt that time due to the patient's co-morbidities, hemodynamic instability and refractory nature of the infection, surgical management was not recommended due to the high mortality. One dose of IVIg 200mg/kg was administered. Subsequently WBC decreased to 25,600. A second colonoscopy on HD#15 showed significantly less pseudomembranes with viable mucosa, no ischemia or thinning and no megacolon, trickle feeds were commenced. On HD#25 he had his first bowel movement, which was negative for CD. Subsequently PR Vancomycin was discontinued. On HD#30 due to the persistent bowel distension on Xray, colonoscopy revealed no pseudomembranes, normal appearing mucosa with stools. Post CD Ogilvie Syndorme was diagnosed.DiscussionAt that time due to the patient's co-morbidities, hemodynamic instability and refractory nature of the infection, surgical management was not recommended due to the high mortality. One dose of IVIg 200mg/kg was administered. Subsequently WBC decreased to 25,600. A second colonoscopy on HD#15 showed significantly less pseudomembranes with viable mucosa, no ischemia or thinning and no megacolon, trickle feeds were commenced. On HD#25 he had his first bowel movement, which was negative for CD. Subsequently PR Vancomycin was discontinued. On HD#30 due to the persistent bowel distension on Xray, colonoscopy revealed no pseudomembranes, normal appearing mucosa with stools. Post CD Ogilvie Syndorme was diagnosed.ConclusionsWe believe that the institution of IVIG was surgery averting for this patient with significant comorbidities even though it has only been described in case reports.Reference #1: J Salcedo, S Keates. Intraveous immunoglobilin therapy for severe Clostridium Difficile colitis. Gut 1997; 41: 366-370DISCLOSURE: The following authors have nothing to disclose: Nicolas Crescimone, Giri Srikanthanoff label use.

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