Colon (tumor & nontumor)
Infectious colitis
Acute self limited colitis
Author: Lili Lee, M.D.
Topic Completed: 1 January 2014
Revised: 9 January 2019, last major update January 2014
Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.
PubMed Search: Acute self limited[title]colitis
Table of Contents
Definition / general | Etiology | Clinical features | Diagnosis | Laboratory | Radiology description | Case reports | Treatment | Clinical images | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Differential diagnosis | Additional referencesCite this page: Lee L. Acute self limited colitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/colonacuteselflimited.html. Accessed August 8th, 2020.
Definition / general
- Due to infections, NSAID or other drugs, bowel preparation or procedure associated injury (eg. gluteraldehyde disinfection of endoscope, Endoscopy 1998;30:428)
- Not always acute or self-limited
Etiology
- Causes:
- Ingestion of pre-formed toxins (Staphylococcus aureus, Vibrio cholera, Clostridium perfringens; cause symptoms within hours including explosive diarrhea)
- Infection by toxigenic organisms (incubation of hours to days)
- Infection by enteroinvasive organisms which invade and destroy mucosal epithelium cells
- Infection by viral organisms (CMV, HSV, HIV, etc.)
- Bacterial virulence factors include:
- Adherence to epithelial cells
- Enterotoxins
- Invasion factors
- Cytotoxicity
- Adherence:
- Via fimbriae or pili
- The process of adherence destroys the microvilli brush border
- Enterotoxins:
- Toxin binds to cell membrane, enters cell, activates massive electrolyte secretion (cholera toxin, E. coli heat-labile and heat-stable toxins produce travelers diarrhea)
- No white blood cells in stool
- Invasion factors:
- Enteroinvasive E. coli and Shigella invade via microbe-simulated endocytosis
- Then intracellular proliferation, cell lysis, cell to cell spread
- Cytotoxicity:
- Shiga toxin, enterohemorrhagic E. coli
Clinical features
- Abdominal pain, watery or bloody diarrhea
- Sudden onset, early fever, often with numerous (greater than 6) bowel movements daily
- Complications of dehydration, sepsis, perforation can occur secondary to potential massive fluid loss and loss of mucosal barrier
Diagnosis
- Stool cultures
- Colonoscopy with mucosal biopsy
Laboratory
- High white blood cell count (leukemoid reaction) with left shift
Radiology description
- Limited role since inflammatory abnormalities are nonspecific (eg. colonic wall thickening)
Case reports
- 56 year old woman with cytomegalovirus infection masquerading as an ulcerative colitis flare-up (Yale J Biol Med 1996;69:323)
- 51 year old man with fecal bacteriotherapy (Case Rep Infect Dis 2012;2012:810943)
Treatment
- Supportive therapy with rehydration
- Rarely may require antibiotics or steroids
Clinical images
Images hosted on other servers:
Gross description
Gross description
- Ulceration, erosion, pseudomembranes, pseudopolyps, hyperemia
Microscopic (histologic) description
- Inflammation of lamina propria (active much greater than chronic), edema, hemorrhage
- Usually lacks features of chronicity (crypt architectural distortion, lymphoplasmacytosis, pyloric gland metaplasia, Paneth cell metaplasia in the left colon)
- Neutrophil induced epithelial injury (cryptitis)
- Severe cases have crypt abscesses, extensive necrosis, hemorrhage and microthrombi
Microscopic (histologic) images
Images hosted on other servers:
Decreased number of goblet cells
Numerous crypt abscess, cryptitis
Purulent cryptitis and dense inflammation
Mucosal bleeding and non-specific inflammation
Neutrophils in surface epithelium
Mild superficial increase in chronic inflammation
Differential diagnosis
- Inflammatory bowel disease: chronic mucosal injury, crypt distortion, basal lymphoplasmacytosis, pyloric gland metaplasia (Am J Surg Pathol 1982;6:523)
Additional references
