Refractory Clostridioides difficile Colitis in a Patient With Hidradenitis Suppurativa: Consequences of Long-Term Clindamycin and Multi-agent Anti-TNF Therapy.

Clostridioides difficile infection (CDI) is a significant cause of morbidity and mortality worldwide, and its treatment is often challenging in patients with complex medication regimens. We report a case of refractory CDI in a 70-year-old woman with Hurley stage II hidradenitis suppurativa (HS) involving the right axilla and perianal region. Her HS was managed with chronic antibiotic use (clindamycin) and anti-tumor necrosis factor (TNF) biologics, initially infliximab (5 mg/kg every eight weeks) followed by adalimumab (40 mg every two weeks) due to inadequate response to infliximab. Despite multiple hospitalizations and treatment with vancomycin and fidaxomicin, the patient experienced recurrent CDI with systemic manifestations including fever, tachycardia, and altered mental status. This case illustrates how chronic antibiotic-induced dysbiosis combined with immunosuppressive therapy can create treatment-resistant CDI requiring multidisciplinary management beyond standard antibiotic protocols.