Nov 2019
• Large volume watery loose stools (10-12 episodes) (nocturnal) with occasional drops of blood, tenesmus and urgency
• No associated pain abdomen, borborygmi, fever or vomiting
• UGIE- normal
• CT enterography- normal
• Sigmoidoscopy- diffuse loss of vascular pattern with erythema and multiple superficial ulcers in rectum and sigmoid
• HPE- moderately dense infiltrates of plasma cells, lymphocytes and neutrophilic focal cryptitis, crypt abscessesà Early IBD
• Steroids and Mesalamine
Feb 2020
• Peri umbilical colicky pain abdomen with distension à better with vomiting (non bilious) or stool passage
• AZT intolerance (TPMT positive)
• F. calprotectin 128
• CMV IgM and DNA PCR- negative
• ANA, anti ds DNA, ASMA, anti LKM1 negative
• Anti tTG negative
• Ileo colonoscopy and CT enterography- normal
• Random biopsies- chronic active infl- consistent with UC till TI
June 2020
• UGIE- nodularity and scalloping in D2
• HPE- focal flattening of epithelium with intraepithelial neutrophilic infiltration; cryptitis, crypt abscess, crypt loss, dense lymphoplasmacytic infiltration in lamina propria, basal plasmacytosis; no granuloma/ dysplasia/ malignancy
• Ileocolonoscopy- normal
• Random HPE- chronic ileitis with activity, crypt loss, increased IELs, chronic proximal predominant colitis with activityà ?Autoimmune enteritis/ IBD
• Video capsule enteroscopy- diffuse loss of small intestinal folds and mucosal atrophyà ? Tropical sprue
• MRCP- GB sludge; normal biliary tree
• ANA profile negative
• Steroids, Pentasa
• Nitazoxanide, antibiotics
On evaluation at AIG HOSPITALS
• CBP normal (Hb 10.3; MCV 102)
• B12- 1008; Vit D 9.2; Iron- 40
• ESR 7
• LFT normal except Albumin 2
• Anti tTG negative
• OGD- D2 scalloping (HPE- mild villous atrophy without IELs)
• Ileo colonoscopy- mucosal edema with patchy vascularity in recto- sigmoid (HPE- mild active infl)
• USG abdomen and CT enterography- normal
Ø 20 years girl on wheat and milk free diet
Ø Large volume watery diarrhea- non bloody; lower abdominal pain with vomiting
Ø D2 scalloping- no increase in IELs
Ø Nonspecific recto sigmoid erythema
Currently in ICU with hypotension
Kindly share your comments?
Antienterocyte antibodies would be