A patient presents with tenesmus and bloody diarrhea. The colon findings extend from the rectum to the mid ascending colon with a normal terminal ileum; histology shows microabscesses in crypts and depletion of goblet cell mucus. Which disease is most likely?

A patient presents with tenesmus and bloody diarrhea. The colon findings extend from the rectum to the mid ascending colon with a normal terminal ileum; histology shows microabscesses in crypts and depletion of goblet cell mucus. Which disease is most likely?

• A. Ulcerative colitis
• B. Crohn disease
• C. Ischemic colitis
• D. Infectious colitis

Answer: (A)

The key idea is recognizing the pattern of inflammatory bowel disease based on where the inflammation occurs and what the tissue looks like under the microscope. Ulcerative colitis causes continuous mucosal inflammation of the colon that starts in the rectum and extends proximally, often sparing the terminal ileum. The colon is involved, but the ileum is typically normal, which fits this case. The microscopic hallmarks—microabscesses in crypts and loss of goblet cells—reflect mucosal neutrophilic invasion and damage to the mucus-producing cells, both classic for ulcerative colitis. Clinically, tenesmus and bloody diarrhea align with a colon-limited, mucosal inflammatory process, especially involving the rectum. Crohn disease, in contrast, usually shows transmural inflammation with skip lesions and often involves the terminal ileum, and may have granulomas or fistulas. Ischemic colitis and infectious colitis don’t match the combination of continuous colonic involvement starting at the rectum, normal ileum, and the characteristic crypt abscesses with goblet cell depletion. So, the presentation and histology best fit ulcerative colitis.

The key idea is recognizing the pattern of inflammatory bowel disease based on where the inflammation occurs and what the tissue looks like under the microscope. Ulcerative colitis causes continuous mucosal inflammation of the colon that starts in the rectum and extends proximally, often sparing the terminal ileum. The colon is involved, but the ileum is typically normal, which fits this case.

The microscopic hallmarks—microabscesses in crypts and loss of goblet cells—reflect mucosal neutrophilic invasion and damage to the mucus-producing cells, both classic for ulcerative colitis. Clinically, tenesmus and bloody diarrhea align with a colon-limited, mucosal inflammatory process, especially involving the rectum.

Crohn disease, in contrast, usually shows transmural inflammation with skip lesions and often involves the terminal ileum, and may have granulomas or fistulas. Ischemic colitis and infectious colitis don’t match the combination of continuous colonic involvement starting at the rectum, normal ileum, and the characteristic crypt abscesses with goblet cell depletion.

So, the presentation and histology best fit ulcerative colitis.