CASE REPORTS Clostridium difficile Brain Empyema after Prolonged Intestinal Carriage

Clostridium difficile, the most common cause of antibiotic-associated diarrhea, is occasionally isolated from extraintestinal sites and is usually found as part of a polymicrobial flora. We report a case of brain empyema that occurred after the recurrent intestinal carriage of a nontoxigenic strain of C. difficile. Brain abscess cultures contained both toxigenic and nontoxigenic isolates. Pulsed-field gel electrophoresis showed that nontoxigenic isolates from the intestine and from the brain were identical. CASE REPORT In February 1999, a 48-year-old man, with a history of chronic alcohol addiction, underwent surgery to drain a sub-dural hematoma that involved the motor sequelae (left hemi-paresis and right hemiplegia) and had caused several epilepsy attacks. During the postoperative hospitalization period, he suffered from several infectious complications, including septic shock secondary to a severe pneumococcal pneumonia (Octo-ber 1999) and acute gangrenous appendicitis of unknown ori-gin (May 2000). On 22 November 2000, he had two epilepti