A 62-year-old man presented with a single personal history of chronic low back pain, which was usually treated with nystagmus.
She came to the consultation for watery diarrhea without fever, accompanied by rectal tenesmus sensation, of almost two months of evolution.
Physical location: no significant findings.
Hematimetry, coagulation and biochemistry with alkaline phosphatase ionogram showed normal values.
CRP: 0.95 mg/dl, ESR: 60 at 1 hour.
TSH and thyroid hormones: normal.
Levels of 5-hydroxyndol-acetic acid (5HIAA) in 24-hour urine: 2 mg/24 hours (within normal limits).
Plasma levels of vasoactive intestinal peptide (PVI): 1 pg/ml.
Antigliadin and antiendomysium antibodies were negative.
Faecal leukocytes: negative.
Serial coprocultives and investigation of Cl difficile, parasites and their eggs in stools: negative.
Esophagogastroduodenal transit
Abdominal ultrasound showed no abnormalities.
Colonoscopy and ileoscopy: macroscopic appearance of normal mucosa without other alterations.
Six biopsies are taken in colon, sigmoid and rectum.
In all of them, abundant subepithelial thickening of collagen of at least 100 μas is observed, in addition to an abundant inflammatory infiltrate in which mononuclear cells predominate.
1.
In the first case, the pathologist suggests the diagnosis of lymphocytic colitis and in the second case of collagenous colitis.
In both cases, due to the poor response to loperamide and the restriction of NSAI, treatment with low residue levels and secretory table is prescribed for 2,400 mg/ day for both eight weeks, after which the diarrhoea disappears.
In both cases, a new endoscopic examination was proposed in order to check the histological remission of the disease, but the patients refused this possibility.
