An Unusual Case of Chronic Diarrhea

Question: An 80-year-old man with a history of Henoch–Schonlein purpura at the age of 59 requiring partial jejunal resection, coronary artery disease, chronic kidney disease, gout, gastroesophageal reflux disease, and prior cholecystectomy was admitted for 2 weeks of guaiac-positive watery brown diarrhea and dehydration. Medications included aspirin 81 mg/d, clopidogrel, aldactazide, furosemide, hydralazine, isosorbide mononitrate, metoprolol, simvastatin, lansoprazole, allopurinol, trazodone, and tamsulosin. He had switched from citalopram to bupropion 2 weeks prior. He was afebrile and hemodynamically stable. His abdomen was distended and tympanitic, with normal bowel sounds and tenderness to palpation over the epigastrium and periumbilical area, but no peritoneal signs. Laboratory evaluation revealed creatinine 1.96 mg/dL, white blood cell count 8.8 × 109/L with 81% neutrophils, and C-reactive protein 27.2 mg/L. Urinalysis, stool culture, Clostridium difficile toxin, ova and parasites, and serum anti-TTG immunoglobulin (Ig)A/IgG were negative. Abdominal computed tomography and upper endoscopy with duodenal biopsies were unremarkable. Colonoscopy revealed a >15-cm, linear ulcer in the descending colon and mild patchy erythema in the proximal colon (). Right and left colonic biopsies showed mildly active colitis, with sloughing of the surface epithelium and increased intraepithelial lymphocytes (). He symptomatically improved during his 6-day hospitalization. After discha...
Source: Gastroenterology - Category: Gastroenterology Authors: Tags: Clinical Challenges and Images in GI Source Type: research