Focal Active Colitis Presented With Chronic Diarrhea

Bayarmaa Mandzhieva

John Taylor

Hammad Zafar

Mamoon Rashid

Abu Khan

^{Internal Medicine, AdventHealth Orlando, Orlando, USA}

^{Internal Medicine, AdventHealth, Orlando, USA}

^{Internal Medicine, Advent Health, Orlando, USA}

^{Gastroenterology, AdventHealth, Orlando, USA}

^{Corresponding author.}

John Taylor moc.htlaehtnevda@od.rolyat.nhoj

Received 2020 Apr 2; Accepted 2020 May 8.

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

There are various etiologies of colonic injury and inflammation. The most commonly described colitides in clinical practice are associated with infection, inflammatory bowel disease, ischemia, radiation and medications. The colonic wall has a limited set of responses to different types of injury; therefore, there is overlap between many of these disorders. Focal active colitis is characterized by isolated neutrophilic cryptitis with the background mucosa displaying normal crypt architecture. This inflammatory pattern can be easily unnoticed by pathologists because on low-power examination the mucosa may have almost normal appearance. General practitioners also may not be familiar with this term, underlying etiologies, associated risk factors, course, available therapies and follow up.

We present a case of an 82-year-old female with chronic diarrhea and weight loss. She had a negative infectious workup and normal radiology series. She subsequently underwent endoscopic evaluation in lieu of persistent and debilitating symptoms which revealed nonspecific macroscopic findings with pathology noting focal active colitis. She was empirically treated with a 14-day course of Xifaxan and responded well to management with almost complete resolution of her symptoms and no recurrence on six-month follow-up.

Keywords: chronic diarrhea, focal active colitis, cryptitis, xifaxan, irritable bowel syndrome, infectious colitis, inflammatory bowel disease.

Notes

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The authors have declared that no competing interests exist.

Human Ethics

Consent was obtained by all participants in this study

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