Pseudomembranous collagenous colitis: an unusual cause of chronic diarrhoea

Abstract

An 81-year-old woman presented with a history of severe chronic diarrhoea resulting in an admission with syncope and electrolyte abnormalities. Imaging studies of the bowel were normal. However, biopsies taken during colonoscopy enabled a diagnosis to be made and effective treatment to be initiated. This case report details the presentation, diagnosis and management of a rare injury pattern affecting the bowel: pseudomembranous collagenous colitis.

Pseudomembranous colitis: Not always Clostridium difficile

“…An increasing number of cases of pseudomembranous changes are being reported in patients diagnosed with collagenous colitis. [32][33][34][35][36] Although the pathophysiologic mechanism is unknown, some authors have suggested that pseudomembrane formation is actually part of the presenting spectrum of collagenous colitis. 36 Inflammatory bowel disease.…”

Pseudomembranous Collagenous Colitis: A Case of Not-so-Microscopic Colitis

“…A thorough history, stool studies, and biopsy may be needed to arrive at the correct diagnosis. There is no evidence to suggest that this variant of microscopic colitis is more resistant to standard therapy 5,6. Therefore, the recent American Gastroenterological Association guidelines for the treatment of symptomatic microscopic colitis with early budesonide therapy should still be followed 7…”

Towards a new paradigm of microscopic colitis: Incomplete and variant forms

“…Other authors described some case reports of pseudomembranous CC as an unusual cause of chronic diarrhoea with a good response to budesonide treatment[ 33 - 38 ]. This variant form was histologically defined as the increased thickening of the sub-epithelial collagen band and pseudomembranes formation characterized by eruptive exudate composed of neuthophil leukocytes, necrotic debris and fibrin at the luminal surface of the colonic mucosa excluding ischemic, toxin-induced or infective aetiologies ( Clostridium difficile infection)[ 36 , 38 ]. The colonoscopy showed normal colonic appearance in some patients, but inflammation and colonic ulcerations in others.…”