Case Discussions

Nov 2019

• Large volume watery loose stools (10-12 episodes) (nocturnal) with occasional drops of blood, tenesmus and urgency

• No associated pain abdomen, borborygmi, fever or vomiting

• UGIE- normal

• CT enterography- normal

• Sigmoidoscopy- diffuse loss of vascular pattern with erythema and multiple superficial ulcers in rectum and sigmoid

• HPE- moderately dense infiltrates of plasma cells, lymphocytes and neutrophilic focal cryptitis, crypt abscessesà Early IBD

• Steroids and Mesalamine

Feb 2020

• Peri umbilical colicky pain abdomen with distension à better with vomiting (non bilious) or stool passage

• AZT intolerance (TPMT positive)

• F. calprotectin 128

• CMV IgM and DNA PCR- negative

• ANA, anti ds DNA, ASMA, anti LKM1 negative

• Anti tTG negative

• Ileo colonoscopy and CT enterography- normal

• Random biopsies- chronic active infl- consistent with UC till TI

June 2020

• UGIE- nodularity and scalloping in D2

• HPE- focal flattening of epithelium with intraepithelial neutrophilic infiltration; cryptitis, crypt abscess, crypt loss, dense lymphoplasmacytic infiltration in lamina propria, basal plasmacytosis; no granuloma/ dysplasia/ malignancy

• Ileocolonoscopy- normal

• Random HPE- chronic ileitis with activity, crypt loss, increased IELs, chronic proximal predominant colitis with activityà ?Autoimmune enteritis/ IBD

• Video capsule enteroscopy- diffuse loss of small intestinal folds and mucosal atrophyà ? Tropical sprue

• MRCP- GB sludge; normal biliary tree

• ANA profile negative

• Steroids, Pentasa

• Nitazoxanide, antibiotics

On evaluation at AIG HOSPITALS

• CBP normal (Hb 10.3; MCV 102)

• B12- 1008; Vit D 9.2; Iron- 40

• ESR 7

• LFT normal except Albumin 2

• Anti tTG negative

• OGD- D2 scalloping (HPE- mild villous atrophy without IELs)

• Ileo colonoscopy- mucosal edema with patchy vascularity in recto- sigmoid (HPE- mild active infl)

• USG abdomen and CT enterography- normal

Ø 20 years girl on wheat and milk free diet

Ø Large volume watery diarrhea- non bloody; lower abdominal pain with vomiting

Ø D2 scalloping- no increase in IELs

Ø Nonspecific recto sigmoid erythema

Currently in ICU with hypotension

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