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Ulcerative colitis in infancy
Md Rukunuzzaman1, A S M Bazlul Karim
1Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. dr.rukon@gmail.com
Insights
Ulcerative colitis (UC), a chronic colon inflammation, is increasingly diagnosed worldwide, even in infants. Early diagnosis and treatment are crucial for managing this rare pediatric condition, especially in regions like Bangladesh.
Area of Science:
- Gastroenterology
- Pediatric Inflammatory Bowel Disease
Background:
- Ulcerative colitis (UC) is a chronic, idiopathic inflammatory disorder of the colon with increasing global frequency.
- UC affects genetically predisposed individuals with altered intestinal immune responses.
- While rare, UC prevalence is noted as 35-100/100,000 in the USA, with 1% affecting infants.
Observation:
- An eight-month-old infant presented with symptoms including loose bloody stool, growth failure, and moderate pallor.
- Diagnostic colonoscopy and biopsy confirmed ulcerative colitis (UC) in the infant.
- The patient received initial induction therapy with parenteral steroids and infliximab.
Findings:
- The infant achieved remission with maintenance therapy including azathioprine and mesalamine.
- Ulcerative colitis is exceptionally rare in Bangladesh, particularly in children and infants.
- Differential diagnoses for recurrent bloody diarrhea in children include infective colitis, allergic colitis, Meckel's diverticulitis, and Crohn's disease.
Implications:
- This case highlights the importance of considering UC in the differential diagnosis of pediatric patients presenting with recurrent bloody diarrhea.
- Prompt diagnosis and appropriate immunosuppressive therapy can lead to remission in even very young patients with UC.
- Increased awareness of UC in pediatric populations is necessary, especially in regions where it is considered rare.
Abstract:
Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder of colon. Frequency of UC is gradually increasing over few years worldwide. Prevalence is 35 to 100/100,000 people in USA, 1% of them are infants. UC develops in a genetically predisposed individual with altered intestinal immune response. An eight-month-old girl presented with loose bloody stool, growth failure, and moderate pallor. The girl was diagnosed as a case of UC by colonoscopy and biopsy. Treatment was thereafter started with immunosuppressive drugs. After initial induction therapy with parenteral steroid and infliximab, the patient is now on remission with azathioprine and mesalamine. UC is rare in Bangladesh, especially in children, and it is rarer during infancy. Several conditions like infective colitis, allergic colitis, Meckel's diverticulitis, Crohn's disease, etc. may mimic the features of UC. So, if a child presents with recurrent bloody diarrhea, UC should be considered as differential diagnosis.
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