Pediatric Collagenous Gastroenterocolitis Successfully Treated with Methotrexate

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.