Photoclinic Diagnosis: Lymphocytic and Collagenous Colitis

The patient was a 59-year-old female suffering from chronic watery diarrhea and abdominal pain for 6 years. She had been evaluated in other hospitals and had been told to have irritable bowel syndrome (IBS). There was no history of weight loss or bleeding. She also complained of flatulence and colicky abdominal pain which was relieved on defecation. Her symptoms showed a fluctuating trend and she believed that the fluctuations were related to her nervous mood. On physical examination, no abnormality was found. All laboratory tests were normal. A colonoscopy performed 3 years ago revealed no abnormal findings. She was given bismuth subcitrate which lead to dramatic response after two weeks. She was advised to take the drug for 12 weeks. A second colonoscopy was performed and biopsies from right and left colon were obtained. Salient images of her colonoscopy and pathology are illustrated.