The patient experienced three more clinical relapses of pseudomembranous colitis over seven months, each accompanied by the reappearance of *Clostridium difficile* or its cytotoxin in stools. Each episode was treated with high-dose oral vancomycin, which effectively controlled the diarrhea and prevented the recurrence of the organism. The patient also suffered from malnutrition and heart failure, and was unable to tolerate cholestyramine. After the sixth relapse, maintenance treatment with oral vancomycin 125 mg every eight hours was initiated, which successfully controlled the diarrhea and prevented further relapses for 10 weeks. The comment discusses the role of ischaemia in the pathogenesis of pseudomembranous colitis, suggesting that it may encourage recolonization of *C. difficile*. It also highlights the importance of caution in using antibiotics in patients with ischemic bowel disease and the potential benefits of a small maintenance dose of vancomycin to prevent relapses.The patient experienced three more clinical relapses of pseudomembranous colitis over seven months, each accompanied by the reappearance of *Clostridium difficile* or its cytotoxin in stools. Each episode was treated with high-dose oral vancomycin, which effectively controlled the diarrhea and prevented the recurrence of the organism. The patient also suffered from malnutrition and heart failure, and was unable to tolerate cholestyramine. After the sixth relapse, maintenance treatment with oral vancomycin 125 mg every eight hours was initiated, which successfully controlled the diarrhea and prevented further relapses for 10 weeks. The comment discusses the role of ischaemia in the pathogenesis of pseudomembranous colitis, suggesting that it may encourage recolonization of *C. difficile*. It also highlights the importance of caution in using antibiotics in patients with ischemic bowel disease and the potential benefits of a small maintenance dose of vancomycin to prevent relapses.