Wan Xue-Meng, Wang Zhi-Ling, Wang Li-Yuan, Cai Xiao-Tang, Wan Chao-Min, Xie Yong-Mei
Department of Pediatrics, Sichuan University West China Second University Hospital, NO. 20, Section 3, Ren Min Nan Lu Road.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P.R. China.
Medicine (Baltimore). 2020 Aug 28;99(35):e21920. doi: 10.1097/MD.0000000000021920.
Collagen colitis (CC) is a microscopic colitis diagnosed by mucosal biopsy and is extremely rare in children.
We reported a child with severe persistent diarrhea that could not be relieved with traditional diarrheal treatment. No abnormalities were found after multiple colonoscopies.
A significant increase in total IgE levels was found in the patient's blood. He had a history of mild chronic allergic rhinitis and slightly intermittent wheezing. However, we found that the child had a hyperallergic reaction to multiple respiratory antigens and had mild pulmonary dysfunction. Finally, colonoscopy with biopsy identified the diagnosis of CC.
Considering that a respiratory allergic reaction was one of the causes of diarrhea, anti-allergic treatment was given to the child, and his severe diarrhea was soon relieved. Corticosteroid treatment was suggested to the patient, but his parents firmly refused steroid therapy. According to the patient's specific allergic reaction to mites, desensitization treatment was finally chosen for him.
After 1 year of desensitization for dust mites, the patient's respiratory symptoms improved, total IgE levels decreased, autoantibodies declined, and diarrhea did not reoccur. Colonoscopy with biopsy showed a significant improvement in pathology.
CC in children is rare, and childhood CC induced by a respiratory allergic reaction has not been previously reported. Therefore, this is a special case of CC in a patient who was cured with anti-allergy treatments and desensitization instead of steroid therapy.
胶原性结肠炎(CC)是一种通过黏膜活检诊断的显微镜下结肠炎,在儿童中极为罕见。
我们报告了一名患有严重持续性腹泻的儿童,传统止泻治疗无法缓解。多次结肠镜检查未发现异常。
患者血液中总IgE水平显著升高。他有轻度慢性过敏性鼻炎病史,伴有轻度间歇性喘息。然而,我们发现该儿童对多种呼吸道抗原存在过敏反应,并伴有轻度肺功能障碍。最终,结肠镜检查及活检确诊为CC。
考虑到呼吸道过敏反应是腹泻的原因之一,对该儿童进行了抗过敏治疗,其严重腹泻很快得到缓解。建议患者使用皮质类固醇治疗,但其父母坚决拒绝激素治疗。根据患者对螨虫的特异性过敏反应,最终为他选择了脱敏治疗。
经过1年的螨虫脱敏治疗,患者的呼吸道症状改善,总IgE水平下降,自身抗体减少,腹泻未再复发。结肠镜检查及活检显示病理有显著改善。
儿童CC罕见,此前尚未有因呼吸道过敏反应诱发儿童CC的报道。因此,这是一例通过抗过敏治疗和脱敏而非激素治疗治愈的CC特殊病例。