Case Submitted by Sara Lewin, MD
A 19 year old man with a history of asthma presents to his local gastroenterologist with 3 months of bloody diarrhea.
He undergoes colonoscopy which demonstrates circumferential and contiguous proctocolitis extending from the splenic flexure proximally to the rectum distally. The mucosa was notable for contact bleeding, friability, erosions with mucoid exudate, loss of vascular pattern, edema, and erythema. There was mild patchy erythema with scattered aphthous erosions of the cecum.
Pathology from colon biopsies showed chronic active colitis with distortion of the glandular architecture.
What is the most likely diagnosis?
Left-sided ulcerative colitis with cecal patch.
These findings are most consistent with ulcerative colitis given the continuous distribution from rectum to the splenic flexure with findings consistent with a cecal patch.
Ileocolonic Crohn’s disease
While Crohn’s disease can have a variety of presentations, the contiguous nature of disease from rectum to splenic flexure is most consistent with ulcerative colitis.
Cytomegalovirus-associated colitis.
This presentation could be consistent with CMV colitis in an immunocompromised patient, but CMV is unlikely to present with the degree or duration of inflammation in an immunocompetent patient
Hemorrhagic E. Coli Enterocolitis.
An E. Coli infection would not be expected to last 3 months in an immunocompetent patient.
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