Let's move to our next case now.
A 65-year-old woman presents
complaining of 5 months of watery diarrhea.
She has 5-6 watery bowel movements
a day with a few episodes at night.
She has no weight loss, bloody
stool, fevers or abdominal pain.
Her only medication is amlodipine
which she takes for hypertension.
On exam, she has normal vitals, an unremarkable
abdomen and her rectal exam is normal.
Colonoscopy shows a normal colon.
And biopsies of the colon are taken that show
many lymphocytes infiltrating the lamina propria.
What is the most likely diagnosis?
So we'll point out that she has 5
months, so that's chronic diarrhea.
She does have episodes of diarrhea at night which
is a clue that suggests a secretory diarrhea.
And she has importantly no alarm symptoms
In addition, the gross appearance of
the colon on colonoscopy is normal.
The next thing we can look at is the lymphocytes
infiltrating the lamina propria on a random biopsy for colon
Putting this together, the gross appearance which is
normal with lymphocyte infiltration on a random biopsy
should hint at a diagnosis
of microscopic colitis.
So, her biopsy results are consistent
with the diagnosis of lymphocytic colitis
We'll talk about that in more detail next.
So, lymphocytic colitis is
a type of microscopic colitis.
This is a chronic inflammation of the colon.
Patients tend to present with
chronic watery non-bloody diarrhea
It tends to affect mostly middle-aged women.
And as with our case, they often have
a normal appearance on colonoscopy.
However, on biopsy, you will find two subtypes,
either lymphocytic colitis or collagenous colitis
The diagnosis is made purely by the biopsy.
And these patients are treated
with antidiarrheals and corticosteroids
Thank you very much for your attention.