Identifiers and Chief Complaint:

56 yo man with c/o diarrhea.

History of the Present Illness:

Patient admitted 4 months ago for severe persistent watery diarrhea of 3 months, diagnosed with C.difficile colitis with positive C. difficile toxin x2. Patient was enrolled in a C.difficile colitis study with improvement of symptoms initially while on the trial drug for about a week, after which it progressively worsened despite continued treatment. He was then given a course of flagyl without any improvement. Repeat C.difficile toxin assay was  negative. Pt continued with severe persistent diarrhea. On this admission he was having 7-15 loose watery non bloody bowel movements/day, with 1-2 nocturnal  bowel movements. No nausea vomiting or abdominal pain. He admitted to severe weakness and loss of appetite, with some subjective weight loss. No relation of his symptoms with meals, and no one else in the family had diarrhea. 

Previous Medical and Surgical History:

Exploratory laparotomy for appendiceal rupture and cholecystectomy. 2003 

S/P lobectomy at MD Anderson for a lung mass turned out to be a fungal mass. 

Coronary Artery Disease, HTN,  NIDDM, and GERD.

Medications:

Furosemide, Lisinopril, Simvastatin, Trazodone, Ibuprofen, Naproxen, Glipizide, ASA and Ranitidine.

Personal and Social History:

No tobacco abuse, social alcohol use only.. Lives with his wife in the suburban community. No well water. No travel in the last 1 year.  

Family History:

Father deceased with lung cancer age 50, Mother died of renal failure secondary to DM at age 60. Brother has  HIV. No family h/o IBD or chronic GI illnesses.