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Microscopic colitis with granulomatous inflammation.
T J Saurine1, J M Brewer, R P Eckstein
1Department of Anatomical Pathology, Pacific Laboratory Medicine Services, Royal North Shore Hospital, Sydney, NSW, Australia.
Histopathology
|July 2, 2004
Summary
Microscopic colitis, a cause of watery diarrhea, can rarely present with granulomatous inflammation. This finding is distinct from Crohn's disease, emphasizing the need for careful histological examination.
Area of Science:
- Gastroenterology
- Pathology
Background:
- Microscopic colitis (MC) is characterized by chronic watery diarrhea and mucosal inflammation without endoscopic abnormalities.
- MC encompasses collagenous colitis and lymphocytic colitis.
Observation:
- Four cases presented with clinical and endoscopic findings of MC but with prominent granulomatous inflammation.
- Symptoms included frequent watery diarrhea in all female patients, with only mild mucosal erythema observed endoscopically.
- Histology revealed active chronic inflammation with non-necrotizing granulomas, often near crypts (cryptolytic/pericryptal).
Findings:
- Clinical presentation and endoscopic findings were dissimilar to Crohn's disease.
- Symptoms in three patients were linked to antibiotic use; two patients were on allopurinol.
- Two patients experienced symptoms for over 10 years; one patient died from complications of severe diarrhea and dehydration.
Implications:
- Microscopic colitis can rarely exhibit granulomatous inflammation.
- Histological differentiation is crucial to avoid misdiagnosis as Crohn's disease.