Case history
Case history
A 27-year-old man with a 3-month history of rectal bleeding and diarrhea is referred for evaluation. Laboratory tests show mild anemia, a slightly elevated erythrocyte sedimentation rate, and the presence of white blood cells in stool. Stool culture is negative. Colonoscopy shows continuous active inflammation with loss of vascular pattern and friability from the anal verge up to 35 cm, with a sharp cutoff. The colonic mucosa above 35 cm appears normal, as does the terminal ileum. Biopsy specimens show active chronic colitis.
Other presentations
Less common presentations include mild distal colitis, in which rectal bleeding may be absent. This can mimic irritable bowel syndrome. Colicky lower abdominal pain may occur, but severe pain is usually limited to severe colitis. Many patients with proctitis present with constipation.
There are several extraintestinal manifestations.[7] Those that are associated with the activity of the colitis include erythema nodosum (2% to 4%), aphthous ulcers (10%), episcleritis, peripheral arthropathy (5% to 10%), and anterior uveitis (1%). Those that are independent of the colitis activity include pyoderma gangrenosum (1% to 2%), sacroiliitis (12% to 15%), ankylosing spondylitis (1% to 2%), and primary sclerosing cholangitis (3% to 7%).[7][8][9]
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