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A 43 year old male with a 7-year history of ulcerative colitis previously well-controlled on azathioprine, presents with 3 days of increasing bloody diarrhea, mild crampy abdominal pain and urgency. On exam he is afebrile with a heart rate of 67 beats per minute and blood pressure of 122/87 mm Hg. His abdominal exam reveals mild diffuse tenderness to palpation without rebound or guarding, no palpable masses and normoactive bowel sounds. A stool test for Clostridium difficile is checked and found to be positive. He is subsequently started on treatment with vancomycin 125 mg Q6 hours. After 3 days of treatment, he continues to have persistent symptoms with no significant change in his diarrhea, pain or urgency.