BACKGROUND Clostridium difficile infection usually manifests as pseudomembranous colitis. Infection of the small intestine is rare. C. difficile enteritis has a high mortality rate due to secondary enteric necrosis and perforation. METHODS We describe an 87-year-old woman with abdominal pain, who died from necrotizing enteritis due to a C. difficile infection. This is the first described case of small bowel involvement in the absence of known risk factors for C. difficile enteritis, i.e. bowel surgery and recent use of antibiotics. The described patient was using immunosuppressants, which in this case could have been a risk factor for small bowel colonization with C. difficile. CONCLUSIONS In clinical practice it is important to be prepared for C. difficile infection, as early treatment of this infection will strongly improve the prognosis. Identification of patients at an increased risk of C. difficile infection is of great value in this respect.