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Background   Clostridium difficile  is the major cause of nosocomial antibiotic-associated diarrhoea with the potential risk of progressing to severe clinical outcomes including death. It is not unusual for  Clostridium difficile infection  to progress to complications of toxic megacolon, bowel perforation and even Gram-negative sepsis following pathological changes in the intestinal mucosa. These complications are however less commonly seen in community-acquired  Clostridium difficile  infection than in hospital-acquired  Clostridium difficile  infection. To the best of our knowledge, this was the first case of community-acquired  Clostridium difficile  infection of its type seen in Jamaica.    Case presentation  We report a case of a 22-year-old female university student who was admitted to the University Hospital of the West Indies, Jamaica with a presumptive diagnosis of pseudomembranous colitis PMC. She presented with a 5-day history of diarrhoea following clindamycin treatment for coverage of a tooth extraction due to a dental abscess. Her clinical condition deteriorated and progressed from diarrhoea to toxic megacolon, bowel perforation and Gram-negative sepsis.  Clostridium difficile  NAP12/ribotype 087 was isolated from her stool while blood cultures grew  Klebsiella pneumoniae . Despite initial treatment intervention with empiric therapy of metronidazole and antibiotic clearance of  Klebsiella pneumoniae  from the blood, the patient died within 10 days of hospital admission.    Conclusions  We believe that clindamycin used for coverage of a dental abscess was an independent risk factor that initiated the disruption of the bowel micro-flora, resulting in overgrowth of  Clostridium difficile  NAP12/ribotype 087. This uncommon strain, which is the same ribotype (087) as ATCC 43255, was apparently responsible for the increased severity of the infection and death following toxic megacolon, bowel perforation and pseudomembranous colitis involving the entire large bowel.  K. pneumoniae  sepsis, resolved by antibiotic therapy was secondary to  Clostridium difficile  infection. The case registers community-acquired  Clostridium difficile  infection as producing serious complications similar to hospital-acquired  Clostridium difficile  infection and should be treated with the requisite importance.

A unique strain of community-acquired Clostridium difficile in severe complicated infection and death of a young adult