International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access
Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc
Journal website https://www.theijcp.org

Case Report

Volume 10, Number 2-3, September 2021, pages 57-63

Challenges in Differentiating Between Solitary Rectal Ulcer Syndrome and Inflammatory Bowel Disease in the Pediatric Population

Figures

Figure 1.
Figure 1. Aphthous ulcers in the rectum.
Figure 2.
Figure 2. Biopsy of the solitary rectal ulcer. There is destruction of the mucosa with a fibrinopurulent exudate seen on the surface and proliferation of reactive capillaries seen beneath, with acute and chronic inflammation seen in the stroma. Colonic mucosa shows distorted architecture with hyperplastic glands, crypt enlargement, uneven spacing and branching. Fibrosis is seen within the stroma. Mild acute and chronic inflammation is present.
Figure 3.
Figure 3. Colonoscopy results during hospital admission showing a localized area of moderately congested mucosa and exudate found in the rectum.

Table

Table 1. Labs During Hospital Admission (Case 2)
 
Complete blood count and platelets
  White blood cell count9.7 × 109/L
  Red blood cell count3.94 × 1012/L
  Hemoglobin (Hb)6.6 g/dL
  Mean corpuscular volume (MCV)58 fL
  Mean corpuscular hemoglobin (MCH)17 pg
  Mean corpuscular hemoglobin concentration (MCHC)29 g/dL
  Red cell distribution width (RDW)16.4%
  Platelets420 × 109/L
Erythrocyte sedimentation rate (ESR)48 mm/h
C-reactive protein2.0 mg/dL
Comprehensive metabolic panel
  Sodium136 mmol/L
  Potassium3.4 mmol/L
  Chloride105 mmol/L
  CO224 mmol/L
  Anion gap7 mmol/L
  Albumin3.3 g/dL
  Alkaline phosphatase67 U/L
  Aspartate aminotransferase (AST)20 U/L
  Alanine aminotransferase (ALT)9 U/L
  Total bilirubin< 0.1 mg/dL
  Conjugated bilirubin0.0 mg/dL
  Unconjugated bilirubin0.2 mg/dL
  Calcium8.5 mg/dL
  Creatinine0.6 mg/dL
  Glucose116 mg/dL
  Total protein6.3 g/dL
  Globulin3.0 g/dL
  Blood urea nitrogen (BUN)15 mg/dL
Magnesium2.0 mg/dL
Phosphate4.1 mg/dL
Uric acid4.5 mg/dL
Prothrombin time/international normalized ratio11.6 s/1.0
Activated partial thromboplastin24 s
Fibrinogen390.0 mg/dL
Lactate dehydrogenase338 U/L
Iron28 µg/dL
Total iron binding capacity401 µg/dL
Transferrin saturation7%
Ferritin3.32 ng/mL
Celiac panel
  Anti-gliadin immunoglobulin A (IgA)Negative
  Anti-gliadin IgGNegative
  Tissue transglutaminase IgANegative
Fecal occult blood test (FOBT)Positive
Fecal calprotectin< 15.6 mg/kg
Gastrointestinal panel
  Campylobacter polymerase chain reaction (PCR), stoolNot detected
  Clostridium difficile toxin A/B PCR, stoolClostridium difficile toxin A/B gene PCR detected
  Clostridium difficile toxin A/B enzyme immunoassay (EIA), stoolNot detected
  Plesiomonas shigelloides PCR, stoolNot detected
  Salmonella PCR, stoolNot detected
  Vibrio PCR, stoolNot detected
  Vibrio cholera PCR, stoolNot detected
  Yersinia enterocolitica PCR, stoolNot detected
  Enteroaggregative Escherichia coli (E. coli) PCR, stoolNot detected
  Enteropathogenic E. coli PCR, stoolNot detected
  Enterotoxigenic E. coli PCR, stoolNot detected
  Shiga-like E. coli STX1/STX2 PCR, stoolNot detected
  E. coli 0157 PCR, stoolNot detected
  Shigella species PCR, stoolNot detected
  Cryptosporidium PCR, stoolNot detected
  Cyclospora cayetanesis PCR, stoolNot detected
  Entamoeba histolytica PCR, stoolNot detected
  Giardia lamblia PCR, stoolNot detected
  Adenovirus F 40/41 PCR, stoolNot detected
  Astrovirus PCR, stoolNot detected
  Norovirus GI/GII PCR, stoolNot detected
  Rotavirus A PCR, stoolNot detected
  Sapovirus PCR, stoolNot detected