Multiple episodes of paediatric Clostridioides difficile infection (pCDI) in the context of autoimmune polyendocrine syndrome type 1

We describe the case of a young child who experienced multiple episodes of Clostridioides difficile infection (CDI) with pronounced meteorism and watery diarrhoea. One episode progressed to severe disease requiring admission to intensive care. Initial CDI episodes were managed with metronidazole and vancomycin. For the recurrent CDI, fidaxomicin-a narrow-spectrum antibiotic with targeted activity against C. difficile-was administered, resulting in sustained clinical remission of CDI-related symptoms. During subsequent follow-up, the patient was diagnosed with autoimmune polyendocrine syndrome type 1 (APS-1), a rare monogenic disorder characterised by immune dysregulation and increased susceptibility to infection. The underlying immunocompromised state likely contributed to the multiple CDI episodes. To our knowledge, this is the first reported case of paediatric CDI associated with APS-1.