We report the case of a 70-year-old man who was admitted for deterioration of his general condition, asthenia, anorexia and weight loss of 1 month of evolution.
She was operated on for prostate cancer. She received several radiotherapy sessions (total dose 70 Gy), the last 12 months before admission, and subsequently received adenocarcinoma treatment.
Since the beginning of radiotherapy, the patient reported a change in intestinal rhythm, alternating with diarrhea and constipation and frequent colic pain, accompanied by urgency and tenesmus of infection.
From the physical examination, it is only worth mentioning a blushing, depressible, non-painful abdomen, with very increased non-pathological noises, without obstructive signs, masses or enlargement.
No lymphadenopathy, fever or other remarkable findings.
Blood tests showed 21,720 /mm3 leukocytes (17.2% neutrophils, rheumatoid phase 800 lymphocytes, 2.4% irregular monocytes 75.3% eosinophils), ESR 60 mm in the first hour, CRP 38.80 mg/L
Transaminase and enzymes of stasis within normal limits.
Antinuclear, antimitochondral and anti smooth muscle antibodies were negative and PSA was 0 ng/mL.
The parasitological study of feces in 3 samples conveniently collected was also negative.
The chest X-ray showed no significant changes.
Establishment and consolidation of the mucosa of 30 cm explored with fibrotic tubular appearance with erythematous dotted, with regular fibrotic stenosis at this level that prevented progression.
Multiple biopsies showed nonspecific acute and chronic inflammation, with no evidence of eosinophils at any level. The presumptive diagnosis was actinic colitis.
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Non-pelvic intravenous contrast-enhanced CT showed diffuse thickening of the small intestine loops at the distal and ileal sites, with no other abnormalities.
No lymphadenopathy was evident at any level or abdominal masses, with radical prostatectomy and thickening of perirectal fat, bladder and rectal wall probably related to previous radiotherapy.
Due to the alterations in the loops, an intestinal transit was carried out, which showed a slight thickening of the valves at the level of the last fold and the remnants of the iliac crest, with the same size as the small intestine, compatible with separation of the first.
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Since the scans performed suggested radiotherapy as the origin of the abdominal picture, and other causes of progressive deterioration of the patient were reasonably ruled out, with 1 mg/day of the patient being empirically treated with corticosteroids descending methylpredni week.
This treatment completely solved both the clinical picture and the analytical alterations, which ruled out the central origin of the disorder.
One week after the start of treatment, the patient was discharged with laboratory tests showing 5,280 leukocytes/mm3 with 1% eosinophils, ESR 27 mm in the first hour and CRP 0.76 mg/L secondary enteritis act.
He remains asymptomatic and with normal laboratory tests.
