Mediterranean mimicker

Abstract

In April, 2009, a 42-year-old woman presented to our department with recurrent febrile attacks (over 38°C) and diffuse abdominal pain that spontaneously subsided within 2–3 days. Laboratory tests showed leucocytosis and raised serum C-reactive protein. Colonoscopy showed discontinuous loss of fine vascular markings, erythema, and friable mucosa in the right hemicolon. Biopsy specimens showed no characteristic features of Crohn's disease or ulcerative colitis. A CT of the abdomen showed abnormal thickness of the colon wall. Capsule endoscopy showed no abnormality of the small intestine. Antisaccharomyces cerevisiae antibodies (ASCA) and antineutrophil cytoplasmic antibodies (ANCA) were negative. She was diagnosed with indeterminate colitis and initially given 4 g of mesalazine per day, followed by 1·5 g for maintenance. However, her symptoms continued and in July, 2009, she was given 40 mg of oral prednisolone daily to control her repeated episodes. Her symptoms subsided, and the dosage was tapered 4 weeks later. Mercaptopurine could not be used because of her intolerability to the drug.