Severe infectious colitis in non-immunocompromised patients: confusion with Crohn’s disease

Abstract

SUMMARY
Objective: Despite a significant progress in diagnostic facilities
infectious colitis may present considerable diagnostic
problems. The aim of the present prospective study was
to establish criteria for clinical and endoscopic diagnosis
and delineate problems of differential diagnosis. Design:
57 cases of severe infectious colitis admitted to a referral
Gastroenterology Department over the last 3 years were
prospectively studied with stool cultures, total colonoscopy
and histological examination. Results: Salmonella species
were isolated from stools of 77% of patients. A peak
during spring time was identified. 22% of patients presented
with severe diarrhoea of more than 10 days duration
while leucocytosis was present in only 39% of cases. Reactive
arthritis was not found in our patients. These clinical
presentation caused considerable confusion and resulted
in inappropriate antibiotic administration in the majority
of patients. Histology was not useful with many false negative
and positive results, in as many as 30% of cases. Skip
lesions and typical apthous ulcers reminiscent of Crohns
disease were found in many cases at colonoscopy, indicating
a consideration of both diseases when such findings
are established. Severe lesions of the left colon, contrasting
with a mild endoscopic picture of the right colon is,
according to our experience, a very useful diagnostic endoscopic
finding. Conclusions: A typical clinical presentation
with endoscopic and histological confusion with Crohns
disease is a common finding in severe infectious colitis. Severe endoscopic lesions of the left colon and mild lesions
of the right colon is a valuable aid in diagnosis.
Keywords: Infectious diarrhoea, endoscopy, salmonellosis