Case history
Case history #1
A 65-year-old woman presents with an 8-week history of diarrhoea, with 5-6 slowly progressive watery bowel movements and nocturnal diarrhoea once or twice per night associated with faecal urgency. She reports mild pain that is relieved after bowel movement. She notes some mucus in stool, no blood or incontinence, and has lost 4.5 kg (10 pounds). Physical examination is unremarkable. Recent blood work-up shows mildly low haemoglobin at 111 g/L (11.1 g/dL; normal range for women 120-150 g/L [12-15 g/dL]). Stool test is negative for Clostridium difficile and other bacterial pathogens. Immunoglobulin A-tissue transglutaminase (IgA-tTG) levels are normal. Ileocolonoscopy shows a normal colon. Biopsy specimens show >20 intraepithelial lymphocytes per 100 surface epithelial cells and lymphocytes, neutrophils, eosinophils, and mast cells in the lamina propria.
Case history #2
A 75-year-old man presents with a 6-month history of diarrhoea. He describes this as constant with 7-8 bowel movements daily and no associated symptoms. He has not lost any weight. Physical examination is unremarkable. He takes ibuprofen daily for arthritis. Recent blood work-up is normal. Stool test is negative for Clostridium difficile and other bacterial pathogens. IgA-tTG levels are normal. Ileocolonoscopy shows mild erythema. Biopsy specimens show a subepithelial collagen band that is typically >7 micrometres to 10 micrometres and chronic inflammatory cells in the lamina propria.
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