Inflammatory bowel disease: Case

This girl presents the classic picture of acute severe ulcerative colitis. Profuse bloody diarrhoea with nocturnal waking, tenesmus, weight loss, iron deficiency anaemia, raised inflammatory markers, and hypoalbuminaemia are the expected features, and a PUCAI of 70 confirms the diagnosis of acute severe colitis. The continuous superficial inflammation from the rectum with crypt abscesses on histology distinguishes ulcerative colitis from Crohn disease. ^[2]

Clinical findings

The pattern is unequivocally that of acute severe colitis. A PUCAI of 65 or greater defines acute severe colitis in children and mandates hospital admission for intravenous corticosteroids. Her anaemia, raised C-reactive protein, and low albumin reflect the severity and systemic nature of the inflammation, and the nocturnal diarrhoea and tenesmus confirm organic disease rather than a functional disorder. The continuous rectal inflammation with crypt abscesses and the absence of skip lesions, perianal disease, or upper-gut involvement fit ulcerative colitis rather than Crohn disease. ^[3]

The differential at presentation included infectious colitis, which is excluded by the negative stool studies, and Crohn disease, which is excluded by the continuous rectal-origin superficial inflammation and the absence of transmural or perianal features. The initial workup followed the ESPGHAN revised Porto criteria with ileocolonoscopy and biopsies, and upper endoscopy would be performed to complete the evaluation and exclude co-existing upper-gut involvement. ^[1]