Metachronous occurrence of collagenous colitis and ulcerative colitis.

Collagenous colitis and ulcerative colitis are distinct disorders. A 67 year old woman with clinical and histological evidence of collagenous colitis had an abrupt symptomatic exacerbation while taking anti-inflammatory treatment with sulphasalazine and prednisone. Repeat colorectal endoscopy showed active mucosal inflammation and colonic biopsy specimens were consistent with active ulcerative colitis. After bowel rest, total parenteral nutrition, intensification of the anti-inflammatory regimen, and withdrawal of non-steroidal anti-inflammatory drugs (which she had taken continuously for osteoarthritis) diarrhoea abated. Colorectal biopsy specimens obtained when the patient's symptoms had improved showed inactive ulcerative colitis with no evidence of collagenous colitis. This may be the first case to be reported of the metachronous association of collagenous and ulcerative colitis.     

Simultaneous occurrence of collagenous colitis and Crohn's disease

A 59-year-old woman who presented initially with clinical and histological features of collagenous colitis subsequently developed Crohn's disease of the small and large bowel.     

Familial occurrence of collagenous colitis. A report of two families

Collagenous colitis is a rare condition characterized clinically by chronic diarrhea and histologically by a thickened subepithelial collagenous band in colonic biopsies in an endoscopically normal colon. Familial occurrence of collagenous colitis has to our knowledge never been described. Here we report two families in which two first-degree related members suffered from collagenous colitis. In one family, two sisters were affected by chronic diarrhea and autoimmune disorders such as thyroid disease, rheumatoid arthritis, and pernicious anemia. Collagenous colitis was diagnosed in one of these sisters, based on colonic biopsies. Colonic biopsies of the other sister showed microscopic colitis. Review of colonic biopsies of this patient taken 11 years earlier, however, showed definite histological features of collagenous colitis. In the other family, in a father and son, both with diarrhea for several years but not suffering from any other diseases, a diagnosis of collagenous colitis was made on colonic biopsies. Human leukocyte antigen (HLA) typing showed that only the HLA A2 antigen was present in all 4 patients.     

Therapy of antibiotic-associated pseudomembranous colitis.

Seven patients treated with oral cholestyramine for antibiotic-associated pseudomembranous colitis are reported. Response was variable with only one patient having a totally satisfactory clinical outcome. Five of seven patients had continued systemic signs with fever and leukocytosis throughout the course of cholestyramine. Two observations were relatively consistent. First, six of the seven patient had a decrease in the number of daily stools during therapy. Second, all patients showed persistence of the cytopathic toxin in stools obtained after three to seven days of cholestyramine therapy. Six patients who were subsequently treated with oral vancomycin had a prompt clinical improvement and clearance of the cytopathic toxin in the stool.     

Rifampicin-associated pseudomembranous colitis

We report a case of pseudomembranous colitis that developed in a patient with liver cirrhosis during anti-tuberculosis therapy with rifampicin and isoniazid. The association between rifampicin and pseudomembranous colitis has been controversial; this report, however, supports the association. Colonoscopy performed 3 days after the onset of the pseudomembranous colitis revealed only reddish patches and a few aphthoid lesions, but 4 days later pseudomembranes were apparent. The pseudomembranous colitis was successfully controlled by discontinuation of the anti-tuberculosis agents, along with the administration of lactic acid bacteria, without vancomycin or metronidazole. Possible predisposing factors for the development of pseudomembranous colitis in this patient are also discussed. Received: February 8, 1999 / Accepted: August 27, 1999     

Non-staphylococcal pseudomembranous colitis

Summary Two weeks after major surgery, pseudomembranous colitis was diagnosed by sigmoidoscopy in a debilitated 51-year-old male. Gram stain and culture of multiple stool specimens were negative for staphylococci or other pathogens. Rectal biopsy confirmed the diagnosis, and recovery was dramatic with supportive therapy and intravenous administration of ACTH. Pseudomembranous colitis is a specific pathologic entity that may occur in a variety of clinical situations. Although it is fulminating at times, this disease can be diagnosed readily and is potentially reversible.     

CT of pseudomembranous colitis

A case is presented in which computed tomography of the abdomen was performed to search for possible peritoneal abscess. The incidental observation of an irregularly thickened wall of the colon led to the diagnosis of pseudomembranous colitis.     

Yersinia colitis masquerading as pseudomembranous colitis

Summary We describe a 15-month-old male who presented with fever and diarrhea 24 hr after receiving antibiotics for otitis media. A flexible sigmoidoscopy was initially interpreted endoscopically as antibiotic-associated pseudomembranous colitis, and the patient was treated with vancomycin. The diagnosis of antibiotic-associated colitis was excluded in our patient by the negative stool examination forClostridium difficile toxin, the failure to obtain supportive features on rectal biopsy, and the failure to demonstrate sigmoidoscopic improvement with vancomycin therapy. Thirteen days later,Y. enterocolitica was cultured from the initial stool specimens. In this case, the raised central whitish area on an erythematous base was misinterpreted as pseudomembranous colitis.     

Joint manifestations in gastrointestinal diseases. 2. Whipple's disease, enteric infections, intestinal bypass operations, gluten-sensitive enteropathy, pseudomembranous colitis and collagenous colitis.

This review addresses the clinical picture of rheumatic diseases seen in Whipple's disease, gluten-sensitive enteropathy, pseudomembranous colitis, collagenous colitis and that developing after enteric infections and intestinal bypass operations for morbid obesity. These disorders exemplify the interplay between antigen entrance through the gastrointestinal canal, specific bacterial properties and genetic host factors such as HLA B27. In most cases such as interplay results in formation of circulating immune complexes causing the development of peripheral joint disease.     

Lymphocytic and collagenous colitis

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