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Focal Active Colitis Presented With Chronic Diarrhea.

Bayarmaa Mandzhieva¹, John Taylor², Hammad Zafar³

¹Internal Medicine, AdventHealth Orlando, Orlando, USA.

|June 19, 2020

Summary

Focal active colitis, an often overlooked inflammatory pattern, can cause chronic diarrhea. Early diagnosis and treatment, as seen in this case study, lead to symptom resolution and improved patient outcomes.

Keywords:

chronic diarrhea cryptitis focal active colitis infectious colitis inflammatory bowel disease.irritable bowel syndrome xifaxan

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Area of Science:

Gastroenterology
Pathology
Internal Medicine

Background:

Colonic inflammation has diverse causes including infection, inflammatory bowel disease, ischemia, radiation, and medications.
Focal active colitis presents as isolated neutrophilic cryptitis, often with subtle mucosal changes, making it challenging to diagnose.
This condition may be unfamiliar to general practitioners, impacting diagnosis and management.

Observation:

An 82-year-old female presented with chronic diarrhea and unexplained weight loss.
Infectious workup and radiology were unremarkable; endoscopy revealed nonspecific findings.
Pathological examination identified focal active colitis.

Findings:

The patient received a 14-day empirical course of Xifaxan (rifaximin).
Significant symptom improvement and near-complete resolution were observed post-treatment.
No recurrence of symptoms was noted at the six-month follow-up.

Implications:

Focal active colitis, though subtle, is a treatable cause of chronic diarrhea.
Empirical treatment with rifaximin can be effective for this condition.
Increased awareness among clinicians is crucial for timely diagnosis and management.