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A pediatric patient with collagenous gastroenterocolitis experienced symptom recurrence after medication withdrawal. Treatment with immunosuppressants and corticosteroids led to sustained remission, highlighting therapeutic options for this rare condition.

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Area of Science:

  • Gastroenterology
  • Pediatric Gastroenterology
  • Immunology

Background:

  • Collagenous gastroenterocolitis is a rare inflammatory bowel disease characterized by a collagen layer deposition in the colon.
  • It often presents with chronic watery diarrhea, malabsorption, and failure to thrive, particularly in pediatric populations.

Observation:

  • A previously healthy two-and-a-half-year-old female presented with prolonged watery diarrhea, emesis, and fevers, leading to severe hypoalbuminemia and hypogammaglobulinemia.
  • Endoscopic and colonoscopic biopsies confirmed collagenous gastroenterocolitis, necessitating parenteral nutrition due to persistent symptoms.

Findings:

  • The patient initially responded to prednisone but relapsed upon transitioning to budesonide.
  • Intravenous prednisone followed by intramuscular methotrexate induced a 15-month remission.
  • Recurrence of collagenous colitis after methotrexate cessation responded well to a short course of oral budesonide, achieving sustained remission.

Implications:

  • This case highlights the potential efficacy of combined immunosuppressive and corticosteroid therapy in managing refractory pediatric collagenous gastroenterocolitis.
  • The findings suggest a potential role for methotrexate in long-term maintenance therapy for this condition.
  • Successful budesonide retreatment indicates its utility in managing relapses, even after prior treatment failures.