Collagenous Gastroduodenitis, Ilieitis and Colitis: A Rare Case in the Literature

Abstract

Purpose: Collagenous gastroenteritidies are relatively uncommon entity. Collagenous colitis is the most common and was first described in 1976 by Lindström. Collagenous gastritis is a rather rare disorder with less than 50 cases being reported in the English literature and was first described in 1989 by Colletti and Trainer. Association of collagenous gastroduodenitis, ileitis and colitis is extremely rare. Clinical presentation depends on the area involved of the gastrointestinal tract. The etiology and prognosis are poorly understood. Three hypotheses have been proposed for the etiology, 1) clinical inflammation and autoimmunity, 2) abnormality of the pericryptal fibroblast sheath and 3) Leakage of plasma protein and fibrinogen, causing subsequent replacement with collagen. The histopathology findings are characterized with subepithelial collagen deposition, dense eosinophils and mucosal inflammatory cells in the lamina propria. We present a 64-year-old woman with 5 months history of nausea, vomiting, watery diarrhea, abdominal pain, weight loss, and anemia. Endoscopy revealed villous atrophy and mosaic patern of the duodenal mucosa, otherwise normal (Figure 1). Multiple biopsies from stomach, duodenum, ileum, colon and rectum were taken. Histopathology revealed collagenous gastroduodenitis, ileitis and colitis (Figure 2). Celiac panel and DLQ2, DLQ8 genetic testing both were negative. The patient was initiated on Prednisone with subsequent improvement of clinical symptoms, subepithelial collagen deposition and inflammatory cells on repeat endoscopy after 3 months. To our best knowledge this is the first reported case in English literature of collagenous gastroduodenitis, ileitis and colitis.Figure: [1354] Endoscopy picture of the duodenum with mosaic pattern and villous atrophy.Figure: [1354] Trichrome staining of gastric antrum revealing subepithelial collagen deposition.