Severe infectious colitis in non-immunocompromised patients: confusion with Crohn’s disease

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2007 (EN)
Severe infectious colitis in non-immunocompromised patients: confusion with Crohn’s disease (EN)

C. Leontidis, E.A. Kouroumalis, Erminia Matrella, Maria Tzardi,

SUMMARY Objective: Despite a significant progress in diagnostic facilities infectious colitis may present considerable diagnostic problems. The aim of the present prospective study was to establish criteria for clinical and endoscopic diagnosis and delineate problems of differential diagnosis. Design: 57 cases of severe infectious colitis admitted to a referral Gastroenterology Department over the last 3 years were prospectively studied with stool cultures, total colonoscopy and histological examination. Results: Salmonella species were isolated from stools of 77% of patients. A peak during spring time was identified. 22% of patients presented with severe diarrhoea of more than 10 days’ duration while leucocytosis was present in only 39% of cases. Reactive arthritis was not found in our patients. These clinical presentation caused considerable confusion and resulted in inappropriate antibiotic administration in the majority of patients. Histology was not useful with many false negative and positive results, in as many as 30% of cases. Skip lesions and typical apthous ulcers reminiscent of Crohn’s disease were found in many cases at colonoscopy, indicating a consideration of both diseases when such findings are established. Severe lesions of the left colon, contrasting with a mild endoscopic picture of the right colon is, according to our experience, a very useful diagnostic endoscopic finding. Conclusions: A typical clinical presentation with endoscopic and histological confusion with Crohn’s disease is a common finding in severe infectious colitis. Severe endoscopic lesions of the left colon and mild lesions of the right colon is a valuable aid in diagnosis. Keywords: Infectious diarrhoea, endoscopy, salmonellosis (EN)




Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 16, No 1 (2003) (EN)

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