Young woman with segmental colitis

Clinical presentation

A 22-year-old woman was referred with a 4-week history of bloody diarrhoea, tenesmus, abdominal and rectal pain. Prior to presentation, a prednisone taper had been initiated given suspicion for Crohn's disease. Her medical history was otherwise unremarkable. Physical exam showed normal vital signs and mild left lower abdominal tenderness without peritoneal signs. Laboratory evaluation was significant for mild leucocytosis (white blood cell count 14.3x10⁹/L (normal range 3.5–10.5x10⁹/L)). CT scan of the abdomen/pelvis showed hazy mesenteric fat stranding, mural thickening, oedema and hyperenhancement involving the rectosigmoid colon with widely patent celiac and mesenteric vessels. Stool testing was negative for enteric pathogens. Flexible sigmoidoscopy revealed a 20 cm segment of purple-appearing mucosa involving the rectosigmoid with evidence of superficial ulcerations and exudate (figure 1A). Corresponding biopsies showed pink 'hyalinised' lamina propria, damage to the tops of crypts and fibrin thrombi in mucosal capillaries. Due to symptomatic persistence after 1 week...

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