A 62-year-old patient with a history of hepatorenal polycystic disease, chronic kidney disease, hypertension, Crohn's disease inflammatory phenotype with involvement of the terminal Crohn's disease and capsule in the abdomen and pelvis underwent computed tomography (CT).
He had undergone resection of the terminal ileum with an loop ileoscendo, due to an episode of lower gastrointestinal bleeding secondary to his illness of anastomosis and had presented two episodes of diverticulum that motivated the suspension of biological therapy.
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In the last two years he developed six episodes of bacteremia due to Escherichia coli, being treated with quinolones (ciprofloxacin) and 3rd generation cephalosporins (ceftriaxone).
An extensive study ruled out another primary focus, including echocardiography and positron emission tomography with computed tomography (CT-PET), among others.
One month after the second episode of bacteraemia due to E. coli, she was hospitalized for a febrile syndrome and diarrhea due to CD (positive toxin A) for 14 days with ileoscopy compatible with pseudomebranous colitis and good oral response.
Approximately one year later, she presented a new febrile episode.
Abdominal and pelvic CT showed a small perforation due to active Crohns disease.
E. coli positive blood cultures were treated with ceftriaxone and metronidazole.
Subsequently, the patient was treated with vancomycin orally for 14 days with good response.
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One month after the fourth episode of E. coli bacteremia, she presented a new episode of CD diarrhea with toxin A and B positive. She was treated with vancomycin orally for 14 days with a good response to vancomycin.
One year later, with prophylaxis for congenital diverticula with rifaximin and tapering, she presented a new CD diarrhea with positive PCR in stools.
He was treated with oral vancomycin for 14 days with good response but relapsed four days after treatment.
He was again treated with vancomycin in progressive decrease and probiotics.
She developed torpid fever, abdominal pain and diarrhea, so she was hospitalized and treated with oral vancomycin associated with intravenous metronidazole (IV).
The patient did not improve on the third day and received immunoglobulin IV 400 mg/kg/day in five doses, with a partial clinical response.
Given the poor outcome in spite of all the therapies tested, it was decided to perform a FMT via puncture with stools from a direct family donor with no history of disease and with pre-transplant study in blood and stools (3) negative.
Treatment with azathioprine and antimicrobials was suspended five days and 24 h before MPT, respectively.
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Procedure description: 69 g of solid depositions diluted in 300 cc of saline solution were used and later discarded.
The solution was instilled from the terminal ileum to the sigmoid, including the area with diverticula.
Twenty-four hours after FMT, the patient developed fever (axillary tox 39°C) with positive blood cultures for E. coli.
She was treated with aztreonam with good clinical and laboratory response.
Ten months after the MPT, the patient developed a new episode of E. coli bacteremia and was treated with aztreonam again.
Two weeks after completing antibacterial treatment she developed diarrhea due to CD with positive PCR for CD.
He was treated with oral vancomycin for 14 days with good response.
One year and four months after the MPT, the patient presented a new episode of diarrhea due to CD (with positive PCR), which was treated with oral vancomycin, progressively decreasing, probiotics and immunoglobulin IV 400 mg/kg/day with good response.
She is currently being treated with azathioprine for her Crohn's disease.
