Collagenous colitis associated with protein losing enteropathy in a toddler

Abstract

Collagenous mucosal inflammatory disease is a rare gastrointestinal disorder that involves the columnar lining of gastric and intestinal mucosa and is characterized by a distinct subepithelial collagen deposition. Recent clinical and pathological evidence have indicated that collagenous mucosal inflammatory disease can be extensive disease that may concomitantly involve several gastrointestinal sites at the same time. This entity, however, occurs infrequently in children. It is even less common to find concomitant depositions of collagen in the mucosa of gastrointestinal sites other than the colon. Only two cases in pediatric literature reported concomitant involvement, one with gastric and colonic involvement and the other one with gastroduodenocolitis. We are reporting a 15-month-old boy who presented with severe diarrhea and diffuse edema secondary to hypoalbuminemia. Further testing documented protein losing enteropathy (PLE) associated with collagenous colitis.

Figure 1

Colonic mucosa with thickened subsurface collagen deposition ((a) hematoxylin-eosin; (b) Masson trichrome, original magnification ×200).

Figure 2

Gastric mucosa with dispersed collagen in lamina propria but not with distinct subsurface collagen deposition ((a), (b) antrum; (c), (d) body; (a), (c) hematoxylin-eosin, (b), (d) Masson trichrome, original magnification ×200).

Figure 3

Duodenal mucosa with only scant foci of subsurface collagen deposition not diagnostic of collagenous duodenitis ((a) hematoxylin-eosin; (b) Masson trichrome, original magnification ×200).