Carton, Daly & Ramani: Clinical Pathology 
'Ask the Author' Forum
Figures from the bookCarton, Daly & Ramani: Clinical Pathology
April 2007: Ulcerative colitis case study
Q: A 37 year old male presents with worsening bloody diarrhoea and crampy abdominal pain over a period of 8 days. The diarrhoea comes on suddenly and does not appear to be related to meals. It is impacting on his sleep and job as a teacher. His past medical history is unremarkable. There is no relevant travel or drug history. Abdominal examination reveals diffuse tenderness. All laboratory results are normal except a reduced potassium and albumin. Colonoscopy shows diffuse erythema of the distal colon. The tranverse colon, proximal colon and terminal ileum appear normal. Biopsy from the abnormal area shows inflammatory cells in the lamina propria and acute cryptitis. Biopsy from the transverse colon is normal.
(Abridged from Shakil Patel, University of Central Lancashire)
A: In summary this is a young male with ongoing bloody diarrhoea associated with crampy abdominal pain. Colonoscopy shows active inflammation in the distal colon with sparing of the rest of the colon and terminal ileum. Biopsy shows an active colitis in the distal colon with normal appearances in the transverse colon. The clinical, endoscopic, and histological picture here would all certainly fit with a diagnosis of ulcerative colitis. The most important differential diagnosis is an acute infectious colitis which must be ruled out with faecal microbiology.
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