Intravenous immunoglobulin therapy for refractory Clostridium difficile toxin colitis in chronic kidney disease: case reports and literature review

Abstract

Clostridium difficile toxin (CDT) colitis is the most common cause of infectious diarrhoea in hospitalized patients and is a frequent cause of morbidity and mortality in hospitalized patients. Failure to mount an immune response to CDT appears to be an important mechanism for recurrent diarrhoea [1, 2]. One of the factors associated with an increased risk for recurrence of CDT colitis is advanced chronic kidney disease (CKD) [1]. There is anecdotal evidence of benefit from treatment with intravenous immunoglobulin (IVIG) in adults with refractory CDT colitis [3–7] following failure of standard treatment with metronidazole and vancomycin [8]. However, none of the cases reported have CKD. We report two cases of CKD patients with refractory CDT colitis, treated successfully with IVIG.