A 24-year-old woman presents with bloody diarrhea (6–8 times/day), tenesmus, and crampy abdominal pain for 6 weeks. Colonoscopy shows continuous mucosal inflammation from the rectum extending to the splenic flexure, with superficial ulcers, loss of haustral markings, and no skip lesions. Biopsies show crypt abscesses and goblet cell depletion. What is the most likely diagnosis?
- A Crohn's disease
- B Infectious (Clostridium difficile) colitis
- C Ulcerative colitis ✓
- D Ischemic colitis
Correct answer: C. Ulcerative colitis
Explanation
Ulcerative colitis is characterized by continuous mucosal inflammation starting from the rectum and extending proximally, superficial ulceration, crypt abscesses, goblet cell depletion, and no skip lesions — all features present here. Crohn's disease has transmural inflammation, skip lesions, and can involve any part of the GI tract from mouth to perianal region. C. difficile colitis is associated with antibiotic use and presents with pseudomembranes; ischemic colitis is typically seen in elderly patients at watershed areas.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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