Ulcerative Colitis Clinical Case Review

Eugenia Uche-Anya, MD, MPH, gastroenterology fellow at Massachusetts General Hospital, explains the baseline characteristics of the case:

"Here is our case: A 62 year old man with hypertension benign prostatic hyperplasia and diverticulosis presents with bloody diarrhea for the past few months. He averages three daily bowel movements, and one nocturnal bowel movement. He notes that his stools intermittently have scant blood in them, and his bowel movements are often associated with urgency and abdominal cramp pain. He denies any nausea, vomiting, weight loss, fevers, chills, recent sick contacts, vision problems, joint aches, or rashes.

His last colonoscopy was 12 years ago. He was noted to have diverticulosis, otherwise his endoscopic exam was unremarkable. He does not take NSAIDS. On lab work, he is found to have an elevated ESR at 28 and an elevated CRP at 40. Stool infectious studies including C diff were negative.

He was found to have an elevated stool calprotectin at 212 suggesting inflammation. A colonoscopy was performed which noted no perianal skin tags or perianal abnormalities. Contiguous erythematic and friable mucosa was seen from the rectum to the sigmoid colon which was suggestive of ulcerative colitis. These areas were biopsied.

The descending colon, transverse colon, descending colon, cecum and terminal ellium were unremarkable besides scattered colon diverticulosis random colon biopsies were taken. Histopathologic analysis revealed mild active proctocolitis in the rectosigmoid colon consistent with chronic ulcerative colitis. No dysplasia or granulomas were seen. Otherwise, random chronic biopsies revealed diagnostic abnormalities."