6/20/22: Subject presented to the ER with one month history of diarrhea, weakness, fatigue, and abdominal pain. Subject was found to be positive for C. Diff, and positive for E. Coli Pyelonephritis. Patient was assessed and was found to be severely malnourished with weight loss (BMI 18.8kg/m2) and has an acute kidney injury. Patient has chronic anemia in the setting of renal disease and malnutrition. Subject was scheduled to receive IP, but it was never administered. 8/1/22 Update: Patient discharged from hospital 6/22/22 and SAE resolved. Course of Vancomycin complete 7/2/22. Per subject, diarrhea symptoms improved on 7/5/22. No new complaints or symptoms related to pyelonephritis. Subject was advised to follow up with primary care provider for a follow up C. Difficile stool sample. Discharge Summary: Prior to Admission She has a history of low frequency high volume watery diarrhea for at least 2 months, around 2 episodes a day, more significant after eating hence associated with weight loss from avoiding food, worsened in the week prior to hospitalization to 3-4 episodes a day. She denies fever, chills, abdominal pain, mucus on the stool. She had some streaks of blood over stool occasionally. She has been able to eat and drink and is trying to keep up with hydration with Pedialyte, water and Gatorade. She felt weaker. She has a distant history of c. Difficile infection. She was seen for this complaint locally, where C. Diff was negative and she was prescribed Augmentin for 7 days for UTI (at that time with dysuria). With no improvement on the diarrhea. She was also found to be anemic, and received 1 unit of blood. She came to clinic this time for annual transplant evaluation on 6/21/22 with concerns of not being able to collect a urine sample because of the diarrhea, she called the Txp clinic, that recommended she was evaluated at the ED. At arrival, she was hemodynamically stable, afebrile. Her creatinine was elevated at 2.25 (baseline 1.6), anemic 8.7, COVID was negative, UA cloudy w/ negative Nitrite, WBC > 100, bacteriuria w/ + Gram-negative bacilli on stain. She received IV fluids and one time dose Ceftriaxone. She does endorses some urinary urgency on chronic urgency/incontinence. CT scan obtained with some renal stranding, that could be related to post transplant status vs evolving pyelonephritis. Given her immunosuppression status, she was admitted for further investigation. Hospital Course- GI pathogen panel was positive for c. Diff and she was started on oral vancomycin QID. Also, urine culture positive for E. Coli pansensitive, she received 3 days of Ceftriaxone, that was transitioned to Cefdinir at discharge based on sensitivities. With her chronic diarrhea, electrolyte disturbances were managed with Magnesium and Bicarbonate supplementation. Dietitian was consulted given severe malnutrition and recommended follow up. She will continue to try alcohol abstinence. Her appointments on the transplant clinic were moved for later this week, and she will continue to follow up with her Primary Care Prover afterwards. Disposition- The patient was discharged to home on 06/22/22 in improved condition. They should follow up with Primary Care Provider regarding malnutrition, chronic diarrhea, recurrent UTI and alcohol abuse. Subject was scheduled to receive vaccination on 6/21/22. Vaccine administration was not performed due to hospitalization and cancellation of all appointments. SAE is no related to Investigational Product.