A case of collagenous colitis with cryptogenic organizing pneumonia

Abstract is not required for Clinical Imagesis not required for Clinical Images (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 8 No. 9, September 2017. ISSN: 0976-3198 Int J Case Rep Images 2017;8(9):617–619. www.ijcasereportsandimages.com Taooka et al. 617 CASE REPORT OPEN ACCESS A case of collagenous colitis with cryptogenic organizing pneumonia Yasuyuki Taooka, Yuka Ide, Yusuke Higashi, Gen Takezawa


CLINICAL IMAGE PEER REVIEWED | OPEN ACCESS
diffuse cloudiness with small fine granule-like surface change from rectum to transverse colon ( Figure 1). Biopsy samples of colon and rectal mucosa revealed infiltration of inflammatory cells into mucosal layer. And submucosal layer and homogenous, amorphous deposition of collagen fiber was recognized under the surface epithelial cells (subepithelial collagen band) ( Figure 2). The diagnosis of collagenous colitis was performed and administration of lansoprazole was discontinued. A few weeks later, watery diarrhea spontaneously discontinued. Six months later, treatment of COP was finished. No recurrence of COP and collagenous colitis after three year.

DISCUSSION
Collagenous colitis is known as one of microscopic colitis, and induces watery diarrhea and chronic colorectal inflammation [1]. As the cause of collagenous colitis with this case, involvement of lansoprazole was suspected. After discontinue of administration of lansoprazole, chronic diarrhea was also stopped. Although it is rare, collagenous colitis is known as the one of the adverse effect of PPI. The COP is classified into one of idiopathic interstitial pneumonias. Etiology of COP is still remained uncertain. And interstitial pneumonia and COP sometimes complicates other organ disorders and connective tissue disease [2,3]. As long as we examined, only two case reports discussing about interstitial pneumonia and collagenous colitis were reported so far [4,5]. Recently, aberrant T cell response and Th1 cytokine were reported to be involved in inflammation of collagenous colitis [6]. Therefore, we could not rule out the possibility of mutual relationship between collagenous colitis and COP. Although both interactions are unclear, there are no reports to deny their interaction. In this case, collagenous colitis occurred during the treatment of COP, and collagenous colitis did not relapse since after remission of COP. Finally, this case was diagnosed as having lansoprazole induced collagenous colitis. Already there are many reports about relevance between PPI and collagenous colitis [5,[7][8][9]. This case had a past history of administration of rabeprazole against peptic ulcer, and there was no diarrhea during administration. Furthermore, this case was treated with omeprazole one year later after remission of COP, and there was not an episode of recurrence of watery diarrhea. After having the diagnosis of collagenous colitis, lansoprazole did not used again in this case. These means collagenous colitis of the case was highly associated with lansoprazole, not other kinds of PPI.

CONCLUSION
A rare case of collagenous colitis was reported. When having chronic diarrhea during treatment with proton pump inhibitors (PPI) including lansoprazole, possibility of adverse effect of PPI should be considered. Colon fiberscopic examination is useful for its diagnosis.

Conflict of Interest
Authors declare no conflict of interest.

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