Lymphocytic colitis: diagnostic challenges in family doctor’s practice - a case report

Microscopic colitis (MC) is a chronic inflammatory disease of the gastrointestinal tract, that typically presents with chronic watery and non-bloody diarrhea.Histopathological examination is crucial to make a correct diagnosis.Two major types of the disease are recognized: collagenous inflammation and lymphocytic inflammation.MC most often affects patients in their seventies and is more common in women.A 67-year-old woman presented with a five-day history of watery diarrhea.Her medical history included multiple chronic diseases and the use of, among others, proton pump inhibitors.The patient received symptomatic treatment with moderate effect.Three months later, she reported persistent diarrhea with mucus, light greenish stools, and lower abdominal pain that did not resolve after treatment with metronidazole and drotaverine.A colonoscopy was performed.Subsequently, the patient requested a home visit due to severe abdominal pain, nausea, vomiting, diarrheal stools with mucus and rectal tenesmus.The referring physician was shown the result of a histopathological examination, which confirmed lymphocytic colitis.Due to a significant worsening of her general condition, the attending physician decided to refer the patient to the internal medicine department.The medical team diagnosed acute renal dysfunction and stabilized renal function.The patient was discharged home on oral budesonide.A significant reduction in diarrheal symptoms was noted.Increasing awareness among family doctors about MC is necessary.Early detection of MC is crucial.