A Case of Collagenous Colitis Following the Prolonged Use of Non-steroidal anti-inflammatory Drugs (NSAIDs)

Moon, Sun Hi; Kim, Chan Gyoo; Jung, Jun Oh; Kim, You Sun; Hwang, Jin Hyok; Kim, Seon Mie; Kim, Byeong Gwan; Park, Dong Young; Jeong, Woon Tae; Lee, Dong Ho; Jung, Hyun Chae; Song, In Sung; Choi, Gyu Wan; Kim, Chung Yong

Abstract

Collagenous colitis is characterized clinically by chronic watery diarrhea and pathologically by increased subepithelial collagen deposition associated with an inflammatory infiltrate in the lamina propria. Its etiology is still unclear, although a variety of associated diseases such as rheumatic syndromes, scleroderma, and thyroid diseases have been reported. We report a case of collagenous colitis following the prolonged use of NSAIDs. A 72-year-old woman who has taken NSAIDs for many years due to some dermatologic problems was admitted to the hospital because of chronic watery diarrhea and colicky abdominal pain of 3 months duration. There was no abnormal physical finding except cachectic appearance due to weight loss of 10kg during 3 months. Stool examination for ova and parasites and fat was negative, and stool culture for bacterial pathogens was negative. In complete blood count, there were relative eosinophila and mild anemia. Total serum protein and albumin was low, and thyroid function, RA factor, FANA were all normal. Results of upper and lower gastrointestinal contrast radiographs were normal. Sigmoidoscopy revealed normal colonic mucosa but she had a thick subepithelial collagenous deposit and chronic inflammation in lamina propria on colonic biopsy. Based on the above findings, she was diagnosed as collagenous colitis. Diarrhea improved after withdrawing NSAIDs and the treatment with oral prednisolone. In the post-treatment biopsy, the thickness of the collagen hand was diminished. Collagenous colitis is now recognized as one of the common causes of chronic diarrhea of obscure origin and NSAIDs may play an etiological role in some patient with collagenous colitis.