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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e3182065fda
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Classic Disease Presenting at the Wrong Age: Rare Cause of Chronic Diarrhea in Children

Haafiz, Allah*; Hu, Yingchuan; Jolley, Christopher*; Liu, Chen

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*Hepatology and Liver Transplantation, Division of Pediatric Gastroenterology, Hepatology and Nutrition, USA

Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, USA.

Address correspondence and reprint requests to Allah B. Haafiz, MD, University of Florida College of Medicine, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, 1600 SW Archer Rd, PO Box 100296, Gainesville, FL 32610 (e-mail: haafiab@peds.ufl.edu).

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

The authors report no conflicts of interest.

A 5-year-old white boy presented with a history of chronic diarrhea, occasional abdominal pain, fecal urgency, and poor weight gain. His medical history was significant for asthma requiring intermittent administration of corticosteroids and albuterol. Family history was negative for autoimmune diseases including celiac and inflammatory bowel disease. Laboratory investigations including stool studies, hemogram, thyroid function tests, celiac serology, esophagogastroduodenoscopy, and colonoscopy (Fig. 1A) were normal. Histological examination of colonic biopsies (Fig. 1B, C, and D) revealed classic features of collagenous colitis (CC), a rare cause of diarrhea in children (1). Considered to be a variant of microscopic colitis, CC is mostly seen in women between 50 and 70 years old presenting with diarrhea (95%), weight loss (41%), abdominal pain (40%), fecal urgency (29%), and nocturnal stools (22%) (2–4). Management of CC is largely empiric, frequently requiring combination of agents from 5-aminosalicylate compounds, glucocorticoids, bile acid resins, bulking agents, and antidiarrheals (5). Since the initial diagnosis 2 years ago, none of these agents have induced a sustained remission of our patient's symptoms, although temporary relief was reported following the use of systemic corticosteroids. The long-term outlook for pediatric CC is not known. In adults, it typically follows a remitting and relapsing course over the span of many years, and the assessment of response to a given therapy may also be a real challenge.

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REFERENCES

1. Gremse DA, Boudreaux CW, Manci EA. Collagenous colitis in children. Gastroenterology 1993; 104:906–909.

2. Fernandez-Banares F, Salas A, Forne M, et al. Incidence of collagenous and lymphocytic colitis: a 5-year population-based study. Am J Gastroenterol 1999; 94:418–423.

3. Lindstrom CG. ‘Collagenous colitis’ with watery diarrhoea—a new entity? Pathol Eur 1976; 11:87–89.

4. Chande N, Driman DK, Reynolds RP. Collagenous colitis and lymphocytic colitis: patient characteristics and clinical presentation. Scand J Gastroenterol 2005; 40:343–347.

5. Schiller LR. Diagnosis and management of microscopic colitis syndrome. J Clin Gastroenterol 2004; 38(5 suppl 1):S27–S30.

Copyright 2011 by ESPGHAN and NASPGHAN

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