A CASE OF UNCLASSIFIED COLITIS WITH PROTEIN LOSING ENTEROPATHY

Abstract

A 50-year-old female visited Shinshu University Hospital in September 1990 with the complaint of diarrhea of approximately 10 months duration. The colonoscopic examination revealed multiple mucosal redness and remarkable mucous discharge in the sigmoid colon and rectum (Figure 1). However mucous existing among the lesions were nearly normal. Histological findings of biopsy specimens from the lesion showed atrophy and inflammatory cell infiltration in the surface of mucosa (Figure3). Culture of feces and serum anti-amoebic antibody were negative. Even with extensive examination, we were not able to classify this case into any hitherto known type of colitis. Alf a-one-antitrypsin clearance test showed that the progressive hypoproteinemia in this case was due to protein losing enteropathy. Metronidazole and oral administration of steroid hormone were not effective. The elementary diet and enema of steroid hormone improved her complaints and endoscopic findings temporarily (Figure 5), but frequent diarrhea recurred immediately after starting oral administration of diet. Surgical resection of sigmoid colon was performed because of resistance to conservative therapy. However, the colitis recurred after 2 months. Home alimentation wiht half digestive element and suppository of small dose of steroid hormone wef e employed continuously for 6 months, and diarrhea and hypoproteinemia were improved. Endoscopic examination showed multiple verrucous lesions, but mucosal redness and mucous discharge were disappeared (Figure 8).