Abstract

To the Editor: A 41-year-old woman with psoriatic arthritis developed watery diarrhea 3 days after starting diclofenac. She had been taking celecoxib for 3 years without having diarrhea. She also started taking etanercept 5 months prior to presentation. She stopped the diclofenac after 2 weeks of diarrhea, and her bowel movements returned to normal. She restarted the diclofenac 1 week later because of worsening joint pain, and her diarrhea recurred after 2 days. Her symptoms persisted despite permanently discontinuing the diclofenac 3 weeks later. Four months after the onset of symptoms, she required admission to a hospital for dehydration. The etanercept was stopped. Her laboratory investigations, including complete blood count, electrolytes, erythrocyte sedimentation rate, albumin, kidney and liver function tests, tissue transglutaminase IgA antibody screen, and stool cultures, were all normal. A computed tomography scan of the abdomen was nondiagnostic. A colonoscopy revealed only mild erythema at the rectosigmoid junction. The pathologic examination of the biopsy specimen revealed marked thickening of the subepithelial collagen layer, and markedly increased numbers of inflammatory cells within the surface epithelium, consistent with severe collagenous colitis (Figure 1). Figure 1. Patient’s biopsy samples. A: Hematoxylin and eosin stain, … Address correspondence to Dr. Kraag; E-mail: grkraag{at}ottawahospital.on.ca

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