A case of diclofenac-induced colitis with focal granulomatous change

We report a case of severe colitis from diclofenac (Voltaren), one of a number of nonsteroidal anti-inflammatory drugs (NSAIDs) that can cause colonic injury. The patient, a 68-yr-old woman, presented with acute onset of bloody diarrhea, having taken diclofenac for more than 2 yr. Colonoscopy revealed deep ulcerations in the transverse colon and erythema and erosions scattered elsewhere. Biopsy findings included crypt distortion, cryptitis, hemorrhage, and some fibrosis. Also, in one biopsy taken from an area of deepest ulceration, a large, non-foreign body-type granuloma was seen, raising the specter of Crohn's colitis. All symptoms subsided within 24 h after discontinuation of the diclofenac, and follow-up colonoscopy 17 days later showed complete endoscopic and histological resolution. Patients and physicians should be aware of the possibility of colitis from NSAIDs. In rare cases, some will show granulomatous change that may be confused with Crohn's disease. Early recognition and discontinuation of NSAIDs is crucial to prevent clinical worsening that could lead to colectomy or even prove fatal.