Differential Diagnosis for Active Patchy Colitis
Single Most Likely Diagnosis
- Ulcerative Colitis (UC): This is the most likely diagnosis given the endoscopy findings of active patchy colitis. UC is a type of inflammatory bowel disease (IBD) characterized by chronic inflammation and ulceration of the colon, which matches the description provided.
Other Likely Diagnoses
- Crohn's Disease (CD): While Crohn's disease can affect any part of the gastrointestinal tract and often presents with skip lesions, it can also cause patchy colitis. The distinction between UC and CD often requires a combination of clinical, endoscopic, and histological findings.
- Infectious Colitis: Certain infections (e.g., Salmonella, Shigella, Campylobacter, and Clostridioides difficile) can cause colitis that may appear patchy on endoscopy. The history of recent travel, antibiotic use, or exposure to sick contacts can support this diagnosis.
- Microscopic Colitis: This condition is characterized by chronic watery diarrhea and normal appearance of the colon on endoscopy, but histological examination reveals inflammation. However, some cases might show subtle changes on endoscopy that could be interpreted as patchy.
Do Not Miss Diagnoses
- Ischemic Colitis: This condition occurs when there is an interruption of blood flow to the colon, which can lead to patchy areas of inflammation and necrosis. It's crucial to consider this diagnosis because it requires prompt treatment to prevent complications like perforation or gangrene.
- Radiation Colitis: A history of pelvic radiation therapy could lead to radiation colitis, which can present with patchy inflammation and strictures. Missing this diagnosis could lead to inappropriate management and worsening of symptoms.
- Diverticulitis: While diverticulitis typically presents with left lower quadrant pain and fever, in some cases, it can cause patchy colitis, especially if there is associated diverticular disease. It's essential to consider this diagnosis due to the potential for complications like abscess formation or perforation.
Rare Diagnoses
- Behçet's Disease: A rare condition characterized by recurrent oral ulcers, genital ulcers, and uveitis, which can also cause gastrointestinal symptoms, including colitis. The colitis in Behçet's disease can be patchy and may resemble IBD.
- Eosinophilic Colitis: A rare condition characterized by eosinophilic infiltration of the colonic mucosa, which can present with patchy colitis. This diagnosis should be considered in patients with a history of atopy or eosinophilia.
- Lymphocytic Colitis: A subtype of microscopic colitis, it can occasionally present with subtle endoscopic changes that might be described as patchy. However, the diagnosis is typically made on histological grounds.