We report the case of a 59-year-old patient who debuts with moderate ulcerative sprout; the diagnosis of CD infection was ruled out because treatment with pancolla and prednisone was started.
Azathioprine and infliximab (IFX) were initiated.
The patient had a first episode of CD infection two days after the first IFX infusion that was treated with metronidazole with good response, so a second dose was administered.
One month later, the patient presented a reinfection and received a new cycle of metronidazole with good response, so a third dose of IFX was administered.
A week later, the patient presented a third episode of CD reinfection with no data on ulcerative colitis (UC) activity.
We started metronidazole and vancomycin with little improvement, removing immunosuppression.
Given the poor outcome, a third line was proposed with fidaxomicin and vancomycin enemas, persisting in rectoscopy pseudomonas on the eighth day.
A fourth line was initiated with step-down of vancomycin and we considered performing a TF in a reference center.
TF was performed on day 25 of treatment fourth line, with immediate response.
Five months later, the patient remains in clinical remission with a dedicated table.
