Teaching casesPseudomembranous collagenous colitis with superimposed drug damage
Introduction
Microscopic colitis (MC) is an idiopathic clinical-pathological entity that consists of chronic watery diarrhea, normal or almost normal endoscopic appearance of the colon, and two histologic patterns: lymphocytic colitis (LC) or collagenous colitis (CC) [4]. The main difference between LC and CC is represented by the presence of collagen deposition immediately beneath the epithelial basement membrane in CC [4].
Collagen deposition has been considered as a phenomenon secondary due to a chronic inflammatory process, forming an anatomical barrier for fluid absorption and causing watery diarrhea [9], or as a process coexisting with the collagen as the cause of diarrhea. The relationship of LC with CC is still not well understood, and some authors consider the two processes as a continuum, LC being an early manifestation of CC [13].
The term pseudomembranous colitis has been used to describe not only the diarrheal syndrome following antibiotic use, often secondary to superinfection by Clostridium difficile [10], but also any mucosal exudative process recognized by the endoscopy or histology. Pseudomembranes have been described in ischemic bowel disease, uremia, irradiation or chemotherapy, and secondary to some bacterial infections, most notably verocytotoxin-producing Escherichia coli 0157-H7 [10].
Pseudomembranous collagenous colitis is a rare distinct entity, described in the last decade, not related to the use of drugs and to superinfections, and characterized by thickening of the subepithelial collagen and formation of pseudomembranes [5], [16], [17]. Here we describe one such case.
Section snippets
Clinical history
A 76-year-old woman who complained of watery diarrhea for one month, without hematochezia, abdominal pain or weight loss, was evaluated. The patient had no significant past surgical or medical history, except for hypertension treated with irbesartan and depressive syndrome treated with escitalopram. Further inquiry concerning use of nonsteroidal anti-inflammatory drugs, including over-the-counter self medications, was negative. Physical examination was unremarkable; blood chemistry revealed
Discussion
The pathogenetic mechanisms of CC are still poorly understood. The well-known association between CC and autoimmune diseases such as thyroiditis, arthritis, celiac disease and idiopathic inflammatory bowel diseases suggests an immunological pathogenesis of the disease [4]. However, other etiological factors have been proposed, including bacterial cytotoxins and local agents. In addition, non steroidal anti-inflammatory drugs have been also implicated in the pathogenesis of CC [2].
There are
Conflict of interest statement
None declared.
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Cited by (12)
Microscopic colitis: lymphocytic colitis, collagenous colitis, and beyond
2023, Human PathologyCitation Excerpt :Pseudomembranous CC is characterized by pseudomembrane formation on top of the classical changes of CC. It is a rare subtype of CC different from conventional CC, which was reported by several studies with a total of 21 patients in the past 3 decades [29,46,78–86]. For most of these cases, stool culture, ova and parasites, C. difficile polymerase chain reaction, and fecal leukocytes were negative.
Endoscopic findings and colonic perforation in microscopic colitis: A systematic review
2017, Digestive and Liver DiseaseCitation Excerpt :Overall, five studies provided data on both CC and LC, and were therefore included in the qualitative analyses of both subtypes. Most of the studies were from the USA (n = 24) [11,13–35]; the other countries of origin were Japan (n = 16) [8,9,36–49], Italy (n = 8) [50–57], France (n = 5) [58–62], Germany (n = 5) [63–67], the UK (n = 4) [6,68–70], Canada (n = 3) [71–73], the Netherlands (n = 3) [74–76] and Sweden (n = 2) [7,77]. Individual case reports came from the following countries: Argentina [78], Finland [79], Greece [80], Hungary [81], Iran [82], Korea [83], Peru [84], Portugal [85], Spain [10] and Turkey [86].
Two cases of atypical microscopic colitis, one with giant cells and another with pseudomembranes
2017, Revista Espanola de PatologiaPseudomembranous colitis
2015, Disease-a-MonthCitation Excerpt :One proposed mechanism is nonsteroidal anti-inflammatory drug (NSAID) and/or estrogen use causing local ischemic changes, as this particular history was obtained in a number of reported cases. It has also been postulated that innate toxic and/or ischemic mechanisms of CC can cause this finding, and that pseudomembranous CC is part of the natural disease spectrum.88–90 Many cases of MC resolve spontaneously, both clinically and histologically.
Phentermine-Associated Pseudomembranous Colitis
2021, American Journal of Therapeutics