SHM Converge Scientific Abstract ePoster Gallery-From Microscopic Colitis to Ulcerative Colitis: A Case of Steroid-Resistant Disease in an Elderly Patient

Pdf Summary

This case describes a rare progression from microscopic colitis, specifically collagenous colitis, to steroid-refractory ulcerative colitis in an 80-year-old man. Microscopic colitis usually causes chronic watery diarrhea but is often considered a relatively benign condition with normal or near-normal colonoscopy findings. In this patient, however, months of worsening diarrhea, profound weight loss, bloating, cramping, anemia, malnutrition, and electrolyte abnormalities signaled a major change in disease course.<br /><br />Initial evaluation in November showed collagenous colitis on colon biopsy, and he was treated with agents such as colestipol, loperamide, mesalamine, and budesonide, though these provided little benefit and budesonide was stopped because of hyperglycemia. By March, he was hospitalized with severe persistent diarrhea, weakness, hyponatremia, hypokalemia, acute kidney injury, and hyperglycemia. Sigmoidoscopy revealed diffuse moderately severe colonic inflammation with ulceration and friability, suggesting ulcerative colitis. Biopsy showed mild active chronic colitis, while stool studies were negative for infection. CT imaging showed diffuse colonic dilatation without wall thickening.<br /><br />Despite IV methylprednisolone, the patient did not improve. He required aggressive supportive care including IV fluids, electrolyte replacement, increased pancreatic enzyme supplementation, cholestyramine, empiric antibiotics, and total parenteral nutrition. Because of steroid resistance, infliximab was started and led to significant clinical improvement. He was ultimately discharged to rehabilitation on a prednisone taper in stable condition.<br /><br />The case highlights that progression from microscopic colitis to inflammatory bowel disease is rare but important. Sudden symptom worsening, especially in older patients, should prompt reassessment for ulcerative colitis or another IBD. It also emphasizes the potential need for early biologic therapy in refractory disease to reduce the risk of severe complications such as toxic megacolon, perforation, and severe malnutrition.

Asset Subtitle

Sara Bertan

Meta Tag

Author List Chiemerie Ogbonnaya, Pooja Patel, Sara Bertan, Zynab Adewusi

Category Clinical Vignettes

Concept Microscopic Colitis

Concept Ulcerative Colitis

Concept Inflammatory Bowel Disease

Concept Watery Diarrhea

Concept Biopsy

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Sara Bertan

Track Adult

Keywords

microscopic colitis

collagenous colitis

ulcerative colitis

steroid-refractory

infliximab

chronic diarrhea

elderly patient

colonic inflammation

malnutrition

electrolyte abnormalities

Microscopic Colitis

Ulcerative Colitis

Inflammatory Bowel Disease

Watery Diarrhea

Biopsy