Vancomycin Treatment for Pneumobilia in Clostridioides difficile Infection: A Case Analysis

Abstract

BACKGROUND Pneumobilia is the presence of air within the biliary tree. It is a relatively rare condition, usually caused by an abnormal communication between the biliary system and the gastrointestinal tract, or by infection from gas-forming bacteria. Antibiotic agents such as fluoroquinolones have many adverse effects, including Clostridioides difficile infection manifesting as colitis. Metronidazole has been used in the past and vancomycin and fidaxomicin can have good therapeutic results. CASE REPORT A 20-year-old man presented to Gennimatas General Hospital in Athens, Greece due to multiple episodes of diarrhea. He had received a 7-day treatment of oral levofloxacin, a common antibiotic treatment often used to treat Clostridioides difficile infection, until 10 days before presentation to our hospital as an outpatient treatment for mild pneumonia. Blood test revealed neutropenia and thrombocytopenia, and biochemical tests revealed hypokalemia and elevated inflammation markers. A CT scan of the abdomen showed pneumobilia. Blood and urine cultures were sterile, whereas Clostridioides difficile toxins A+ and B+ were detected in stool culture. Treatment with oral vancomycin had excellent results. The patient improved clinically and remained afebrile, with cessation of diarrhea, correction of electrolytic disorders, and disappearance of pneumobilia on a repeat CT scan after 1 week. CONCLUSIONS Pneumobilia caused by Clostridioides difficile infection was effectively treated with orally administered vancomycin, which cured our patient's diarrhea and pneumobilia.

Figures 1

(A–C) Day 0. Arrows show pneumobilia-air within the biliary system.

Figure 2

(A, B) Normal liver on day 7. Arrows show a normal biliary tree without pneumobilia.