An 11-year-old male was followed up in the PC clinic for diarrhea and unquantified weight loss of one month evolution.
liquid and explosive stools, number 5-10 a day, with red blood and mucus without pus, unaware of fasting and wake up at night
This condition has not improved with oral rehydration serum and probiotics.
She did not report any personal or family history of interest, recent trips or family epidemic environment.
The patient is located in the Gastroenterology Department of the Children's Hospital.
Physical restraint: weight 60 kg (> P97); height 161 cm (> P97); TA 123/85 mm Hg; temperature 36.7 oC; heart rate 82 bpm.
Good nutritional status; good general condition; normal color, well hydrated and nourished.
No rashes or petechiae.
Head and neck: no cervical masses.
Cardiac and pulmonary consolidation was normal.
Abdomen: blando and depresible, painful to severe constipation at the periumbilical level and left flank; without hepatomegaly.
Anal infection: perianal erythema without fissures.
Return of examination by normal equipment
Analytical: leukocytes 12 900/μl (70.7% neutrophils); hemoglobin 13.9 g/dl; hematocrit 41.6%; platelets 375 000/μl; glucose 99 mg/dl; albumin IgG/dl 11
feverish peak on the second day of admission was 39 oC.
Microbiological study: negative blood cultures; negative stool cultures; Clostridium difficile toxin and rotavirus antigen.
Serology was negative for hepatitis A, B and C, cytomegalovirus and Epstein&#146;s virus.
An abdominal ultrasound is performed, which is reported as mural thickening of the transverse colon and left colon, with inflammatory changes of adjacent fat and presence of locoregional lymphadenopathies.
It is complemented with magnetic resonance imaging (MRI) that confirms the findings and signs, without finding involvement of the small intestine.
A fixation is made, introducing the end to what seems to correspond to the splenic angle.
Continued involvement is observed with a very friable mucosa on the cheek and samples are taken at 100, 70, 55, and 45 cm from the anal margin.
Removal of the rectal mucosa shows involvement of the petechial aspect without other focal lesions.
In all samples for histopathological study were observed lesions that were continuous and affected all fragments.
The lesions corresponded to erosions with continuous epithelialization.
Architecture distortion caused chronic damage.
In addition, the degree of activity at the time of the biopsy was moderate to severe, with the presence of microabcesses and frequent crypts.
No granulomas were observed.
There were no images of transmural ulceration, and the lesions were limited to the mucosa (epithelium and corion), with little involvement of the submucosa.
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The patient was treated with corticosteroids at a dose of 60 mg/day (for four days to later be switched to oral therapy) and oral table 1 g/8 hours.
After improvement, the patient was discharged 10 days after admission with a diagnosis of possible ulcerative colitis and outpatient treatment with oral contraceptive pill (1 g/day, oral contraceptive pill), methylprednisolone (20 mg/day).
