title: Defecation of a "colon cast" as a rare presentation of acute graft-versus-host disease.
abstract: Diffuse involvement of the gastrointestinal tract by graft versus host disease (GVHD) is a common complication of allogeneic hematopoietic stem cell transplant (HSCT). Gastrointestinal GVHD usually presents 3 or more weeks after HSCT and is characterized by profuse diarrhea, anorexia, nausea, vomiting, abdominal pain and gastrointestinal bleeding. We report a case of a 23-year-old male who had undergone allogeneic HSCT and presented with bloody diarrhea on the 90th day post-HSCT. On the fourth day of admission, the patient passed per rectum a 27-cm long pinkish colored fleshy material recognized as a "colon cast". Sigmoidoscopy showed a congested and erythematous rectum with the remaining portion of the "colon cast" attached to the proximal part of the sigmoid colon. A biopsy from the rectal wall was suggestive of grade IV GVHD. The patient was treated with methylprednisolone, cyclosporin and mycophenolate mofetil, with a partial response (diarrhea and abdominal pain improved), but then he developed multiple other medical complications and died after 3 months.
authors.affiliation: Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Hamad
authors.initials: H
authors.lastname: Al Ashgar
authors.forename: Musthafa
authors.initials: M
authors.lastname: Peedikayil
authors.forename: Naeem
authors.initials: N
authors.lastname: Chaudhri
authors.forename: Abdulmonem
authors.initials: A
authors.lastname: Al-Ghamdi
mesh_terms: D000208:Acute Disease; D000741:Anemia, Aplastic / Q000601:surgery; D003672:Defecation; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000150:complications* / Q000175:diagnosis; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012810:Sigmoid Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012812:Sigmoidoscopy; D014184:Transplantation, Homologous; D055815:Young Adult