Case history
Case history #1
A 65-year-old woman presents with an 8-week history of diarrhea, with 5-6 slowly progressive watery bowel movements and nocturnal diarrhea once or twice per night associated with fecal 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 exam is unremarkable. Recent blood workup shows mildly low hemoglobin at 11.1 g/dL (normal range for women 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 diarrhea. He describes this as constant with 7-8 bowel movements daily and no associated symptoms. He has not lost any weight. Physical exam is unremarkable. He takes ibuprofen daily for arthritis. Recent blood workup 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 micrometers to 10 micrometers and chronic inflammatory cells in the lamina propria.
Use of this content is subject to our disclaimer