Four-child Hungarian case report tracks fecal microbiota transplantation for one year

Fecal microbiota transplantation was followed by different clinical outcomes in four seriously ill children treated at two tertiary paediatric centres in Budapest, Hungary, according to a prospective case report. The children were treated between 2025 and 2026 for fulminant treatment-refractory Clostridioides difficile infection, severe C. difficile infection in a child with Crohn’s disease, pan-refractory acute gastrointestinal graft-versus-host disease and intestinal carriage of multidrug-resistant organisms in IPEX syndrome. Their clinical courses were recorded for one year.

Two children with C. difficile infection had no recurrence during follow-up. The child with fulminant infection achieved remission by day 14 and remained recurrence-free at one year. The child with Crohn’s disease and severe infection returned to her pre-infection stool pattern by day 14 and also remained free of C. difficile recurrence at one year. These were individual outcomes in a small case series rather than evidence of a general treatment effect.

The first patient received fecal microbiota transplantation through a nasojejunal or nasogastric tube after developing fulminant C. difficile infection that had not responded to treatment. The procedure was associated with remission by day 14 in the reported clinical course, followed by no recurrence through the one-year observation period. Because the report included no comparator, it cannot determine how much of the outcome was attributable to transplantation or how the result would compare with other care.

The second patient was a girl with Crohn’s disease and severe, treatment-refractory C. difficile infection. She received transplantation by colonoscopy and returned to her pre-infection stool pattern by day 14. She remained free of C. difficile recurrence at one year. The report provides evidence that transplantation was delivered in this selected paediatric case, but it does not establish efficacy for Crohn’s disease or for severe C. difficile infection more generally.

The third child was treated for pan-refractory acute gastrointestinal graft-versus-host disease. Transplantation was delivered in lyophilised oral capsules, and the child achieved complete clinical control of the gastrointestinal condition by day 14. The child died on day 50 from haemorrhagic complications of cerebral fungal infection. No adverse event was judged directly attributable to fecal microbiota transplantation, but donor-derived transmission of the fatal fungal infection could not be definitively excluded.

That unresolved possibility limits interpretation of the third case. Improvement in the acute gastrointestinal manifestations occurred before the fatal infection, but the sequence does not establish whether transplantation contributed to the infection. The investigators therefore documented both the observed control of graft-versus-host disease and the uncertainty surrounding the source and route of the fungal infection.

The fourth child had IPEX syndrome and intestinal carriage of multidrug-resistant organisms. In this case, decolonisation was the therapeutic aim rather than treatment of a gastrointestinal disorder. Initial transplantation with lyophilised oral capsules did not eliminate carriage by day 14. The procedure was repeated on day 60, after which cultures were negative on days 90 and 365.

Administration methods varied according to the individual case. Nasojejunal or nasogastric tubes and oral capsules were used for three children, while one child received transplantation by colonoscopy. The routes, diagnoses, clinical objectives and outcomes were not uniform, making direct comparisons among the four cases inappropriate. The report also combined conditions for which the intended outcomes differed, from infection remission and clinical control to microbiological decolonisation.

The investigators described no adverse event as directly caused by transplantation. Nevertheless, the case series does not establish the procedure’s safety or efficacy across severe gastrointestinal disorders because it included only four children, no comparator group and several distinct treatment goals. The authors concluded that larger controlled studies are required to assess patient selection and long-term outcomes. The findings are therefore preliminary observations from selected cases, not proof of routine benefit or safety.

Subject of Research: One-year clinical outcomes of fecal microbiota transplantation in four seriously ill children treated for severe gastrointestinal disorders or multidrug-resistant organism carriage.

Article Title: Fecal microbiota transplantation in children with severe gastrointestinal disorders: the first Hungarian paediatric experience with 1-year follow-up

Article References: SZABÓ, B. G., KORÓZS, D., PETRIK, B. R., HAJÓSI-KALCAKOSZ, S., CZELECZ, J., TAKÁCS, L., VISNYOVSZKI, Á., CSORDÁS, K., KASSA, C., DEÁK, Á., BEDNÁRIK, D. S., HORVÁTH, M., KRIVÁN, G., & KÁLLAY, K. (2026). Fecal microbiota transplantation in children with severe gastrointestinal disorders: the first Hungarian paediatric experience with 1-year follow-up. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07901-4

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DOI: 10.1186/s12887-026-07901-4

Keywords: fecal microbiota transplantation, paediatric gastroenterology, Clostridioides difficile, Crohn’s disease, graft-versus-host disease, IPEX syndrome, multidrug-resistant organisms, case report, Hungary, microbiome therapy, Fecal, microbiota