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Miscellaneous
An unusual cause of rectal bleeding in a patient with rheumatoid arthritis
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  1. A Hokama,
  2. K Tanaka,
  3. M Nakamoto,
  4. N Uchima,
  5. F Kinjo,
  6. A Saito
  1. First Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan
  1. Correspondence to:
    Dr A Hokama
    First Department of Internal Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan; hokama-amed.u-ryukyu.ac.jp

http://dx.doi.org/10.1136/gut.2004.062406

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    Clinical presentation

    A 75 year old woman presented with rectal bleeding of 10 days’ duration. She had a 26 year history of rheumatoid arthritis and duodenal ulcer. Medications included prednisolone 5 mg, famotidine 20 mg, and indomethacin suppositories 100 mg, all daily. On examination, there was no tenderness in the abdomen. Haemoglobin was 10.0 g/dl. Colonoscopy revealed a diaphragm-like stricture with circumferential ulcer in the rectum (fig 1). Biopsies showed mild non-specific inflammation without granulomas and vasculitis. Culture of stool and biopsies were negative. Tuberculin test was negative.

    Figure 1
    Figure 1

     Colonoscopy showing a diaphragm-like stricture with circumferential ulcer in the rectum.

    Question

    What is the diagnosis?

    See page 1071 for answer

    This case is submitted by:

    Footnotes

    • Robin Spiller, editor

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    • Miscellaneous
      Answer
      BMJ Publishing Group Ltd and British Society of Gastroenterology
      Gut 2005; 54 1071-1071 Published Online First: 11 Jul 2005.