Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 5 2025 04 26 221 223 Sattar Jafari Department of Gastroenterology, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Shalaleh Aghaei Department of Internal Medicine, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Behnam Sajedi Department of Gastroenterology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran. Samira Akbarieh Department of Infectious and Tropical Diseases, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran. 2025 01 18 2025 02 02 Clostridium difficile infection (CDI) is commonly associated with nosocomial diarrhea; however, certain atypical presentations can challenge its diagnosis. We report a case of CDI in a 25-year-old male with inflammatory bowel disease (IBD), presenting with unusual clinical features, including abdominal distension, lower extremity edema, and persistent non-bloody diarrhea. Diagnostic uncertainty arose due to the patient’s prior IBD diagnosis and atypical symptoms. Nevertheless, CDI was confirmed through stool toxin assay and colonoscopy findings of pseudomembranes. Treatment with oral vancomycin resulted in complete symptom resolution, underscoring the importance of considering CDI in cases with atypical symptoms. Prompt diagnosis is essential for effective management and prevention of complications. https://crcp.tums.ac.ir/index.php/crcp/article/view/1015 https://crcp.tums.ac.ir/index.php/crcp/article/download/1015/689