Collagenous colitis in a patient with common variable immunodeficiency.
9
Citation
0
Reference
20
Related Paper
Citation Trend
Keywords:
Common Variable Immunodeficiency
Cite
Summary A case of collagenous colitis in a young female with a rapid response to sulphasalazine both symptomatically and histologically is reported. This is only the third such response to be reported. In most published accounts, collagenous colitis fails to respond to treatment and runs a very prolonged course.
Sulfasalazine
Collagenous Colitis
Cite
Citations (17)
Microscopic colitis (MC) is prevalent in adults investigated for chronic watery diarrhea, yet characterization of pediatric MC is limited.Our pathology database was searched from 1995 to 2011 for pediatric cases of lymphocytic colitis (LC) or collagenous colitis (CC). Those with diarrhea persisting for >2 weeks and visually normal colonoscopy were accepted as cases. Demographics, laboratory results, medication use within 3 months of presentation, medical and family history of autoimmune disease, and response to treatment were abstracted.A total of 27 cases were histologically consistent with MC on biopsy; 5 with concomitant enteric infection or isolated abdominal pain were excluded. Twenty-two cases of MC (female patients, 59%; median age at diagnosis, 15.3 years) were included (19 LC and 3 CC). Two had type 1 diabetes mellitus, 2 were anti-nuclear antibody positive, and 2 had common variable immunodeficiency. Of 20 patients who underwent an esophagogastroduodenoscopy, 1 had collagenous sprue and 4 had celiac disease. One presented after the clearance of recurrent Clostridium difficile infection. Previous drug exposures included nonsteroidal anti-inflammatory drugs (n = 7), proton pump inhibitors (n = 6), and selective serotonin reuptake inhibitors (n = 3). Common symptoms in addition to diarrhea included abdominal pain (77.3%) and weight loss (27.3%). Of 17 patients with follow-up, all of the 8 treated with steroids had some response: 57.1% (4/7) responded to mesalamine and 42.9% (3/7) responded to bismuth subsalicylate.In this cohort of pediatric patients, LC was much more common than CC. As described in adults, we observed associations with celiac disease, type 1 diabetes mellitus, and medications; we additionally saw an association with immunodeficiency. Our patients showed greater response to steroids than mesalamine or bismuth.
Lymphocytic Colitis
Collagenous Colitis
Esophagogastroduodenoscopy
Cite
Citations (18)
Collagenous colitis is an inflammatory mucosal disorder of the colon with distinctive histopathological features, including a thickened subepithelial collagen layer. The clinical course is usually benign, but serious complications, including death, may occur. In the present report, a 69-year-old woman with watery diarrhea and collagenous colitis developed bloody diarrhea that was refractory to treatment medications, including corticosteroids and azathioprine. Endoscopic and histopathological studies showed a focal neutrophilic inflammatory process that progressed to a diffuse and extensive form of colitis, eventually requiring total proctocolectomy. Careful histological review of the resected colon showed no evidence of persistent collagenous colitis. These findings suggest an important need for continued long-term follow-up of patients with collagenous colitis because superimposed and serious colonic complications may occur, including a severe and extensive pancolitis refractory to medications and necessitating total proctocolectomy.
Bloody diarrhea
Pancolitis
Collagenous Colitis
Proctocolectomy
Ischemic Colitis
Refractory (planetary science)
Cite
Citations (35)
Collagenous colitis is a condition characterized by chronic, watery diarrhoea, which is diagnosed histologically as most cases reveal a normal colonoscopic appearance. The aetiology is poorly understood, but nonsteroidal anti-inflammatory drugs or infections may act as triggers for an immune-mediated process. In this report, an unusual case of collagenous colitis associated with pseudomembrane formation is described. Stool assay was negative for Clostridium difficile cytotoxin B. There are only three reports of pseudomembranes in collagenous colitis in the absence of C. difficile infection. In addition, the patient had a deficiency in immunoglobulin production, which may suggest an infective trigger to collagenous colitis. This is the first report of an association between an immunoglobulin deficiency and this unusual variant of collagenous colitis. The implications of these findings are discussed.
Collagenous Colitis
Common Variable Immunodeficiency
Etiology
Cite
Citations (27)
Common Variable Immunodeficiency (CVID), a group of 20–30 heterogeneous disorders, is associated with a broad spectrum of clinical manifestations including gastrointestinal diseases. Common manifestations include nodular lymphoid hyperplasia, inflammatory bowel disease (Crohn's, ulcerative colitis), giardiasis, pernicious anemia, and sprue-like illness. In this report, a rare case of collagenous colitis associated with CVID is described. A patient with an 11 year history of CVID, stable on monthly IV gammaglobulin therapy, presented to the clinic with progressively worsening loose bowel movements over a course of 3 years. Stool culture was negative for ova and parasites, blood and mucus. Upper gastrointestinal endoscopy showed normal appearing esophagus, stomach, duodenum and jejunum as well as a normal colonoscopic appearance. Duodenal biopsies showed no evidence of giardiasis and terminal ileum biopsies were unremarkable. Random colonic biopsies demonstrated microscopic colitis consistent with collagenous colitis. Immunostaining for CD3 highlighted numerous intramucosal lymphocytes, and trichrome stain revealed a thickened subepithelial collagen band. Collagenous colitis, a rare entity itself, occurs in small percentage of patients who present with chronic diarrhea. The prevalence of CVID is approximately 1 in every 50,000 and to discover this combination is unusual, as there has only been one reported case thus far in the reviewed literature. This report highlights the presentation, diagnostic workup and clinical course in this patient with a rare combination of unusual conditions.
Common Variable Immunodeficiency
Collagenous Colitis
Cite
Citations (0)
Microscopic colitis is a common cause of chronic diarrhea. It is characterized by non-bloody watery diarrhea with macroscopically normal colonic mucosa. Its specific histological characteristics confirm the diagnosis. Two distinct histological forms can be identified, namely, collagenous colitis and lymphocytic colitis. In collagenous colitis, a thick colonic subepithelial collagenous deposit can be observed, whereas in lymphocytic colitis, a pronounced intraepithelial lymphocytic inflammation in the absence of a thickened collagen band can be identified. Microscopic colitis occurs more frequently in elderly females and its etiology is believed to be multifactorial, although smoking and consumption of several drugs have been identified as risks factors for the development of the disease. The treatment is based on avoiding the risks factors and administration of oral budesonide.
Lymphocytic Colitis
Collagenous Colitis
Bloody diarrhea
Etiology
Intraepithelial lymphocyte
Cite
Citations (5)
Collagenous Colitis
Joint disease
Cite
Citations (0)
Introduction: Microscopic colitis is a chronic, inflammatory disease of the colon that is characterized by chronic, watery diarrhea. The diagnosis is established by biopsy of colonic mucosa as Colon appears normal on Colonoscopy[1] Case: A 73 y.o. female with collagenous colitis (on budesonide), recurrent C. difficile infection, Multiple sclerosis, presented with altered mental status, and diarrhea. Patient reported 4-6 watery bowel movements daily. Vitals were significant for tachycardia and mean arterial pressure of 66. Physical exam was significant for abdominal distension and decreased bowel sounds. Labs were significant for leukocytosis (15.8), elevated creatinine (2 times her baseline) and Non Anion Gap Metabolic Acidosis and C. Difficile toxin detected on PCR. CT abdomen showed localized ileus in left hemi-abdomen. Patient received 14 days of Oral Vancomycin and Intravenous Flagyl for treatment of severe C. Difficile infection with complications [2]. Serial Abdominal X-ray's were done which showed improvement and patient had 1-2 formed stools at discharge. Discussion: C. Difficile infection can be treated with Oral/Intravenous Flagyl and/or Oral Vancomycin depending upon severity of disease [2,3]. Our patient had 4 admissions over a course of 2 months for watery diarrhea. She was treated with appropriate antibiotics with resolution of her symptoms completely. Her diarrhea recurred with increased severity in each admission despite being on oral budesonide to prevent collagenous colitis flare. We hypothesize that concomitant use of Oral steroids in C.Difficile infections increase recurrence and alternate medications should be considered such as anti TNF therapy [4, 5]
Cite
Citations (0)
Collagenous Colitis
Crohn disease
Cite
Citations (1)
Department of Pathology, University of Michigan Hospitals, Ann Arbor, Michigan. Reprint requests to: Joel K. Greenson, MD, Department of Pathology, University of Michigan Hospitals, Room 2G332, Box 0054, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0054.
Reprint
Cite
Citations (3)