anticoagulation. Follow-up CT abdomen/pelvis three weeks after admission displays significantly improved enhancement pattern throughout the liver with minimal residual heterogeneous enhancement. The patient reports improvement in her abdominal pain during follow-up appointments, and her liver enzymes are trending back to normal levels. She follows up outpatient with hematology/oncology, however her hypercoagulable lab work-up continues to be unremarkable. Discussion: This case demonstrates that portal vein thrombosis may occur following COVID vaccination. The timeline of her developing portal vein thrombosis soon after receiving the COVID vaccination may be suggestive of the vaccine precipitating her condition. This patient did have an additional risk factor of tobacco use. This can be a challenging situation for many clinicians to navigate, as COVID remains a significant threat to patients' health. Patients with hypercoagulable risk factors may benefit from close monitoring for abdominal pain or other symptoms surrounding COVID vaccination.

Clostridium difficile infection (CDI) is the most common infectious cause of nosocomial diarrhea, comprising 10-20% of all cases. CDI is a significant complication in patients with inflammatory bowel disease (IBD). New monoclonal antibody therapies have emerged as leading treatment options for recurrent CDI (rCDI). Bezlotoxumab, a novel monoclonal antibody, has shown success in decreasing the recurrence rates of patients with rCDI. However, data extrapolating diminished rCDI in patients with concomitant IBD is limited. This case supports the findings in the MODIFY I/II trials that Bezlotoxumab is a viable treatment option of rCDI in IBD patients.

Figure 1. Top left: Index EGD showing a single cratered 8mm ulcer in the duodenal cap. Top right: Index EGD with active Dieulafoy bleed in the duodenal sweep, just distal to ulcer. Bottom left: 2nd EGD showing free floating suture material and ischemia in the fundus Bottom right: 2nd EGD showing obvious fistula with ischemic changes, obscured by clot and old blood during index endoscopy.