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Colitis - CT Scan Results
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Colitis - CT Scan Results

20 year old female. Blood in stool, abdominal pain. ANA+,(all other lupus panel negative) joint pain, mouth ulcers, blood in urine off and on(1mm kidney stone)  All other blood work normal.  Was on steroids and Asacol last summer for 5 months...weaned off

Current CT scan: Mildly prominent fluid filled small bowel loops with no evidence of obstruction. Suggestion of mild wall thickening involving the terminal ileum. Focal area of mild wall thickening involving a small bowel loop in the left lower quadrant. No significant inflammatory changes.

Colonoscopy May 2008 - Duodenal mucosa increased numbers of lymphocytes. Acute inflammation, villous atrophy, eosinophilia.  Terminal ileal mucosa increased eosinophils up to 30. Occasional eosinophilic cryptitis. Actule inflammation, villous atrophy, granulomas, and dysplasia.  Portions of colonic mucosa with focal acute cryptitis, crypt abscess, infiltration of chronic inflammatory cells and eosinophils. Scatter neutrophils in lamina propria.

Colonoscopy biopsy May 2008 : 1st pathologist - acute colitis;  2nd pathologist - UC;  3rd pathologist - not sure, most likely UC

Colonoscopy 3 months later August 2008: Normal

pANCA positive

Capsule endoscopy July 2008 - showed one area of ulcer in small intestine and 3 possible polyps

Double baloon endoscopy through mouth showed nothing, but as he was going deep into small intestine, it became stiff and unpliable and darker in color - couldn't go any further - biopsies all normal.

Advice please ........More likely Crohns? UC? Lupus?

Started again recently with blood in stool.  
Started on Pentasa - 1 pill 250mg 4x a day. - is this dose too low?
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I can't make a definitive diagnosis without personal evaluation, but it appears that there are conflicting results.

On one hand, the prior biopsies suggested inflammatory bowel disease, but the most recent one, did not.  It is possible that it was taken during an acute flare, which may have led to a positive result.  

I do agree with the capsule endoscopy.  If there continues to be concern in the small bowel, a push enteroscopy can be considered.  Another consideration would be the anti-OmpC, which can shed more light on the diagnosis as well.  

If the symptoms continue, another colonoscopy and biopsy can be performed, preferably at a major academic medical center.

Regarding lupus, more antibody testing can be done, including, the anti-double-stranded DNA (dsDNA) antibodies and anti-Sm antibodies.  Both are highly specific for the disease.

These options can be discussed with your personal physician.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.

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