title: Collagenous colitis in systemic sclerosis: an overlooked and treatable complication.
abstract: Collagenous colitis (CC) is an inflammatory bowel condition of unknown etiology. Systemic sclerosis (SSc) has been associated with CC in a few cases, but it is not clear whether CC could be considered an unusual manifestation of SSc or an independent condition. Here we present a case of SSc-associated CC and compare routine histology and immunofluorescence studies for allograft inflammatory factor 1 and caveolin 1 expression with other cases of CC and healthy controls. All CC biopsies showed characteristic sublaminal collagen accumulation and a decrease of caveolin 1 expression, this latter finding consistent with and common in any fibrotic reaction. In contrast, the expression of allograft inflammatory factor 1 was increased only in the SSc-CC specimen, suggesting a distinct pathogenesis. A literature review revealed 6 previously reported cases of SSc-CC with common clinical features. These observations suggest that CC should be suspected as a rare gastrointestinal complication of SSc and that clinicians should be aware of the possibility in SSc patients developing watery diarrhea.
authors.affiliation: From the *Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; and †NIHR Leeds Musculoskeletal Biomedical Research Unit and ‡Department of Histopathology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; and §Department of Rheumatology, University of Lund, Lund, Sweden.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Abignano
authors.forename: Nigel
authors.initials: N
authors.lastname: Scott
authors.forename: Frank A
authors.initials: FA
authors.lastname: Wollheim
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
authors.forename: Maya H
authors.initials: MH
authors.lastname: Buch
authors.forename: Francesco
authors.initials: F
authors.lastname: Del Galdo
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D019819:Budesonide / Q000008:administration & dosage*; D046729:Colitis, Collagenous / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D003113:Colonoscopy / Q000379:methods; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D064747:Lansoprazole / Q000008:administration & dosage*; D018570:Risk Assessment; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D064747:Lansoprazole; D019819:Budesonide