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Lymphocytic venulitis: an unusual association with microscopic colitis
D S Arora1, T Mahmood, J I Wyatt
1Department of Histopathology, St James's University Hospital, Leeds, UK.
Journal of Clinical Pathology
|September 4, 1999
Summary
A 79-year-old man experienced chronic gastrointestinal bleeding and anemia, leading to a colectomy. Microscopic examination revealed lymphocytic venulitis and colitis, suggesting a specific inflammatory bowel disease.
Area of Science:
- Gastroenterology
- Pathology
Background:
- Investigating the cause of chronic, occult gastrointestinal bleeding and severe anemia in an elderly patient.
- Evaluating the diagnostic yield of surgical intervention when endoscopic and radiological investigations are inconclusive.
Observation:
- Patient presented with a two-year history of unexplained gastrointestinal bleeds and anemia.
- Received extensive blood transfusions (40 units) over one year.
- Underwent subtotal colectomy due to persistent bleeding with no apparent macroscopic cause.
Findings:
- Macroscopically, the resected colon appeared unremarkable.
- Microscopic examination revealed prominent lymphocytic venulitis in the proximal colon.
- A transition zone showed progression to lymphocytic and collagenous colitis in the distal colon.
Implications:
- Highlights the importance of detailed histopathological examination in diagnosing obscure gastrointestinal bleeding.
- Suggests that lymphocytic venulitis and collagenous colitis can present as a spectrum of disease.
- May indicate a specific, albeit rare, inflammatory process contributing to chronic blood loss.