Inflammatory Bowel Disease-Pathology

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Slide 60.   Acute Self-Limited (Infectious) Colitis

Generally speaking, ‘acute self-limited colitis,’ while a term reasonably applied to the clinical behavior of many infectious enterocolitides, is not exclusively an acute mucosal injury according to the definitions presented earlier.  Although a neutrophilic infiltrate in the lamina propria is often conspicuous, the typical infectious disorder in the colon is also associated with cryptitis and crypt abscess formation.  In this respect, acute self-limited colitis is really a form of active mucosal injury.  The upper crypts are usually involved, but as this image demonstrates, full thickness mucosal inflammation may be present.  To varying degrees, increased numbers of lymphocytes and plasma cells may also be seen in infected foci, but the basal lymphoplasmacytosis and chronic injury pattern of inflammatory bowel disease are typically missing.  In this context, note in this image the uniform spacing of crypts in cross-section.  Crypt abscesses in acute self-limited colitis, unlike the destructive mid or lower crypt lesions seen in ulcerative colitis, often form in the upper crypt and are associated with atrophic crypt profiles (insert).  The lack of aggressive crypt destruction in usual examples accounts for the lack of chronic mucosal injury (loss of crypts, mucosal fibrosis, and crypt architecture distortion).  As emphasized earlier, although various infectious organisms can cause focal cryptitis in a distribution similar to that of Crohn’s disease, the latter almost always is associated with evidence of chronic injury, even in its initial clinical presentation.

Nostrant TT, Kumar NB, Appelman HD: Histopathology differentiates acute self-limited colitis from ulcerative colitis.  Gastroenterology 1987; 92:318-328.

Surawicz CM, Haggitt RC, Husseman M, et al.: Mucosal biopsy diagnosis of colitis: acute self-limited colitis and idiopathic inflammatory bowel disease.  Gastroenterology 1994; 107:755-763.