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The histopathologic spectrum of acute self-limited colitis (acute infectious-type colitis)
Abstract:
Acute self-limited colitis (ASLC) is a self-limiting diarrheal illness which is often caused by known infectious agents (Campylobacter, Salmonella, and Shigella), but many cases are of unknown etiology. This report describes the histopathologic features of acute self-limited colitis as related to its natural history. The extent of inflammation and regeneration varies with the duration of the disease. In the peak activity stage (within 0-4 days of onset of bloody diarrhea) there is mucosal edema, cryptitis, crypt ulcers, and abscesses. At the time of resolution (within 6-9 days of onset of bloody diarrhea), regenerative features become apparent along with residual focal neutrophilic cryptitis. In the latter stages of resolution, along with some regenerative features, occasional crypts with transmigrating lymphocytes may be present. A rectal biopsy is diagnostic only in the early stages of the disease. Later in the course, the rectal biopsy from patients with ASLC may be nondiagnostic or may be confused with Crohn's disease due to the persistence of focal cryptitis. In our experience, the presence of crypt distortion and basal plasmacytosis are the two most useful criteria to differentiate chronic ulcerative colitis from ASLC.
Insights
Acute self-limited colitis (ASLC) shows distinct histopathologic changes over its course. Early rectal biopsies are diagnostic, but later stages may mimic Crohn's disease.
Area of Science:
- Gastroenterology
- Pathology
- Colitis Research
Background:
- Acute self-limited colitis (ASLC) is a diarrheal illness often infectious but sometimes of unknown cause.
- Understanding ASLC's histopathologic features is crucial for diagnosis and management.
Purpose of the Study:
- To describe the histopathologic features of ASLC in relation to its natural history.
- To identify diagnostic criteria for differentiating ASLC from other colitis types.
Main Methods:
- Histopathologic examination of rectal biopsies.
- Correlation of findings with disease duration and clinical presentation.
Main Results:
- Early ASLC (0-4 days) shows edema, cryptitis, ulcers, and abscesses.
- Resolution (6-9 days) reveals regenerative changes with residual inflammation.
- Later stages may present with features mimicking Crohn's disease, making rectal biopsy less diagnostic.
Conclusions:
- Rectal biopsy is most diagnostic in early ASLC.
- Crypt distortion and basal plasmacytosis are key features to distinguish ASLC from chronic ulcerative colitis.