Chronic

A 23 year old woman presents with blood and mucus diarrhea, low grade fever, lethargy, and malaise for 1 week. She experienced around 3 to 4 bowel movements daily.

She had several such episodes over the last 4 months, which were unsuccessfully treated with multiple courses of antibiotics. She had gone backpacking around South Asia 6 months earlier.

An x-ray of her abdomen is found to be normal.

Select Relevant Investigations
Full Blood Count

Performed

WBC/DC: 8,700/mm3
N: 75%
L: 23%
Hb: 10.5 g/dl
MCV: 88 fl
MCH: 31.2 pg
MCHC: 30 g/dl
Platelets: 517,000/mm3
Tuberculin Test

Performed

The tuberculin test is negative.
Lower GI Endoscopy

Performed

The mucosa of the rectum and sigmoid colon appear uniformly inflamed, with multiple erosions. There is no contact bleeding. Biopsies show inflammation of the mucosa and submucosa only, with distortion of the crypts, crypt abscesses and lymphoid aggregates.
Stool Microscopy + Culture

Performed

Appearance: semi solid
Pus cells: field full / hpf
RBC: field full / hpf
No amoeba, ova or cysts identified

The stool cultures are negative

Select Relevant Management
Mesalazine stat
Azathioprine stat
Antituberculous therapy
Vancomycin stat