A CASE OF YERSINIA ENTEROCOLITICA DIVERTICULITIS MIMICKING INFLAMMATORY BOWEL DISEASE: THE IMPORTANCE OF DIFFERENTIAL DIAGNOSIS
Abstract:
We present the case of a 64-year-old male, referred to our ambulatory unit for colonoscopy. The patient complained about repeated mild rectal bleeding and abdominal pain. He was afebrile and had no weight loss. Initial laboratory showed a mildly elevated erythrocyte sedimentation rate, no anemia or leukocytosis. Repeated routine stool culture was negative. Colonoscopy revealed macroscopic changes of the mucosa suggestive of Crohn disease associated with acute diverticulitis. Histopathology showed chronic and acute inflammation, cryptitis and cryptic abscess suggestive for ulcerative colitis. Treatment was started with 5-ASA (aminosalicylate) derivates and Rifaximin, but bleeding worsened and 5-ASA derivates were stopped. Serology for Yersinia enterocolitica IgA and IgG was positive. Antibiotherapy with Ciprofloxacin was started, followed by rapid improvement with stool normalization. The case suggests the importance of differential diagnosis and the use of serology for excluding unusual infections, despite the presence of highly suggestive macroscopic changes for inflammatory bowel disease.
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