Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Case Report
Abstract
Introduction: Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by recurring episodes of inflammation limited to the mucosal layer of the colon. Traditionally, this disease has been associated mostly with white Americans, however in recent years, an increase incidence has been reported in minorities in the US and around the world. In Hispanic population, cases are frequently underdiagnosed, and literature is scarse. In this case, we present a young patient without past medical history who presented with what appeared to be an infectious gastroenteritis and found to have a severe UC.
Case Presentation: A 22-year old Hispanic female with no known past medical history presented to the emergency department with a 1 month history of right lower quadrant abdominal pain and hematochezia. The abdominal pain was described as episodic, moderate to severe, stabbing-like sensation that was usually associated with episodes of hematochezia and diarrhea. Pain was exacerbated prior to bowel movements and relieved after defecation. She reported having at least 10 or more episodes of diarrhea daily. She denied any other associated symptomatology and had no contributive family history. Upon arrival, her vital signs were T 100.9, HR 136, RR 20, BP 104/80 mm Hg and SPO2 of 96% on room air. Physical examination was consistent with dehydration, abdominal distention with increased tenderness on RLQ and positive rectal exam for blood. Labs upon admission were WBC 18.91, Hb 12, Ht 38, Platelets 593, Na 131, K 3.1, Cl 93, HCO3 23 and Creatinine 1.0. Gastrointestinal (GI) panel was positive for Enteroaggregative E. coli and negative for C. difficile infection. CT abdomen and pelvis without contrast revealed bowel wall thickening of the entire colon, concerning for colitis. She was admitted for sepsis in the setting of lower GI bleed due to E. coli specie. After 2 days of ciprofloxacin, patient persisted with symptoms priory mentioned. Fecal calprotectin was ordered due to concern of underlining IBD and was 1500 ug/g. GI service was consulted and patient underwent immediate colonoscopy, revealing severely inflamed colon with erosions, erythema, and deep ulcerations in a continuous and circumferential pattern from the rectum to the cecum. Patient was placed on IV steroids and after having negative Hepatitis panel and Tb test, she underwent first dose of Infliximab. Patient had improvement on the frequency and consistency of her bowel movements and was able to tolerate diet. She was later discharged with oral steroids and to follow closely with GI for following doses of Infliximab.
Discussion: Ulcerative colitis manifestations have been described in specific subgroups of Hispanic population, such as South Americans or Caribbeans (1-2), however not all Hispanic entities groups have the same characteristics and may have differences not applicable to others. In a retrospective cohort analysis done by Mendoza et al in a city located near the US-Mexico Border, they found that UC was significantly more prevalent than Chron´s disease. There was no difference on extent of disease compared between ethnicities, but this population had lower use of immunodulators and biologics, which could be secondary to socioeconomic issues in the area (3). In our case, we present a patient who did not had any contributory past medical or family history with worsening abdominal pain associated with hematochezia, who was treated as GI infection and after 48 hours of poor response, IBD workup was pursued. The perception of IBD within Hispanic population should be modernized, so better medical care may be provided.
Academic/Professional Position
Resident
Mentor/PI Department
Internal Medicine
Recommended Citation
Gonzalez Morales, Elimar; Gomez Casanovas, Jose; Patel, Shreel; and Haj-Yahya, Khairiya, "Newly diagnosed Ulcerative Colitis in a Young Hispanic Mexican Female at South Texas: A Case Report" (2024). Research Symposium. 52.
https://scholarworks.utrgv.edu/somrs/2024/posters/52
Included in
Newly diagnosed Ulcerative Colitis in a Young Hispanic Mexican Female at South Texas: A Case Report
Introduction: Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by recurring episodes of inflammation limited to the mucosal layer of the colon. Traditionally, this disease has been associated mostly with white Americans, however in recent years, an increase incidence has been reported in minorities in the US and around the world. In Hispanic population, cases are frequently underdiagnosed, and literature is scarse. In this case, we present a young patient without past medical history who presented with what appeared to be an infectious gastroenteritis and found to have a severe UC.
Case Presentation: A 22-year old Hispanic female with no known past medical history presented to the emergency department with a 1 month history of right lower quadrant abdominal pain and hematochezia. The abdominal pain was described as episodic, moderate to severe, stabbing-like sensation that was usually associated with episodes of hematochezia and diarrhea. Pain was exacerbated prior to bowel movements and relieved after defecation. She reported having at least 10 or more episodes of diarrhea daily. She denied any other associated symptomatology and had no contributive family history. Upon arrival, her vital signs were T 100.9, HR 136, RR 20, BP 104/80 mm Hg and SPO2 of 96% on room air. Physical examination was consistent with dehydration, abdominal distention with increased tenderness on RLQ and positive rectal exam for blood. Labs upon admission were WBC 18.91, Hb 12, Ht 38, Platelets 593, Na 131, K 3.1, Cl 93, HCO3 23 and Creatinine 1.0. Gastrointestinal (GI) panel was positive for Enteroaggregative E. coli and negative for C. difficile infection. CT abdomen and pelvis without contrast revealed bowel wall thickening of the entire colon, concerning for colitis. She was admitted for sepsis in the setting of lower GI bleed due to E. coli specie. After 2 days of ciprofloxacin, patient persisted with symptoms priory mentioned. Fecal calprotectin was ordered due to concern of underlining IBD and was 1500 ug/g. GI service was consulted and patient underwent immediate colonoscopy, revealing severely inflamed colon with erosions, erythema, and deep ulcerations in a continuous and circumferential pattern from the rectum to the cecum. Patient was placed on IV steroids and after having negative Hepatitis panel and Tb test, she underwent first dose of Infliximab. Patient had improvement on the frequency and consistency of her bowel movements and was able to tolerate diet. She was later discharged with oral steroids and to follow closely with GI for following doses of Infliximab.
Discussion: Ulcerative colitis manifestations have been described in specific subgroups of Hispanic population, such as South Americans or Caribbeans (1-2), however not all Hispanic entities groups have the same characteristics and may have differences not applicable to others. In a retrospective cohort analysis done by Mendoza et al in a city located near the US-Mexico Border, they found that UC was significantly more prevalent than Chron´s disease. There was no difference on extent of disease compared between ethnicities, but this population had lower use of immunodulators and biologics, which could be secondary to socioeconomic issues in the area (3). In our case, we present a patient who did not had any contributory past medical or family history with worsening abdominal pain associated with hematochezia, who was treated as GI infection and after 48 hours of poor response, IBD workup was pursued. The perception of IBD within Hispanic population should be modernized, so better medical care may be provided.