Hemorrhagic colitis and pseudomelanosis coli in ipecac ingestion by proxy.
This report describes a toddler with chronic diarrhea, vomiting, and hypotonia due to surreptitious administration of syrup of ipecac by his mother (Munchausen's syndrome by proxy). Several features of this case distinguish it from previous reports of chronic ipecac ingestion in childhood: the development of grossly bloody stools; radiologic, endoscopic, and biopsy evidence of a chronic moderate colitis resembling ulcerative colitis; and the histologic finding of pseudomelanosis coli, providing an important clue to toxic ingestion. The significance and possible mechanism for genesis of pseudomelanosis coli is discussed. This case emphasizes the variability in presentation and difficulty in diagnosing long-term ipecac ingestion by proxy. Ipecac toxicity should be considered in children with unexplained colitis and vomiting.
Department of Medicine, University of North Carolina, Chapel Hill 27599-7220.
J E
JE
Johnson
B L
BL
Carpenter
J
J
Benton
R
R
Cross
L A
LA
Eaton
J M
JM
Rhoads
D001706:Biopsy; D002908:Chronic Disease; D003092:Colitis / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D003108:Colonic Diseases / Q000139:chemically induced* / Q000473:pathology; D003113:Colonoscopy; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D006801:Humans; D007223:Infant; D007486:Ipecac / Q000009:adverse effects*; D008297:Male; D008548:Melanosis / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D009110:Munchausen Syndrome
D007486:Ipecac