Lymphocytic colitis usually presents in middle- or older-aged adults (6
). Studies (6
) report a female predominance, with female to male ratios ranging from 5.75:1 to 1:1. Studies (6
) have shown a link between a variety of drugs (eg, nonsteroidal anti-inflammatory drugs, lansoprazole) and lymphocytic colitis.
Familial occurrences of lymphocytic colitis have been reported (21
), in addition to associations with thyroid disorders, diabetes mellitus, inflammatory bowel disease and others (4
). Celiac disease has been found in 6% to 27% of patients with lymphocytic colitis (5
). This relationship may be mediated by shared haplotype HLA DQ2 (12
), although this haplotype was not increased in patients with lymphocytic colitis in another study (4
). In one study (24
), lymphocytic gastritis was found in 33% of patients with celiac disease, and lymphocytic colitis was found in 38% of those with both celiac disease and lymphocytic gastritis (24
Although cases of celiac disease with coexistent colon carcinoma have been reported (25
), studies have not shown an increased incidence of colorectal neoplasms in patients with celiac disease; nevertheless, colonoscopic evaluation for possible neoplasm in patients with iron deficiency anemia is an important investigation (26
We performed a PubMed literature search for case studies published between 1980 and August 2007 that described lymphocytic or collagenous colitis associated with colorectal cancer. We also examined review papers of microscopic colitis published in the same period. There were no reports of an association between lymphocytic colitis and colorectal cancer. Although some studies (28
) demonstrated no increased risk of cancer in patients with collagenous colitis, there were three case reports of collagenous colitis associated with colon cancer. Two of these (14
) described collagenous colitis associated with colon cancer in female patients in their seventh decade of life. Another (15
) showed both symptomatic and histological resolution of collagenous enterocolitis in a 52-year-old woman after surgical intervention for localized colon cancer, and suggested that this was a paraneoplastic phenomenon.
The present paper describes an 81-year-old man with latent lymphocytic enterocolitis. After the initial presentation, he remained asymptomatic from this disease before developing a one-year history of diarrhea and associated symptoms. A comparison of biopsy specimens from his most recent colonoscopy with previous biopsy specimens showed changes in lymphocytic enterocolitis.
Because the course of lymphocytic colitis is uncertain, and may worsen or resolve on its own (8
), it is possible that it may have contributed to his initial presentation when diagnosed with colon cancer, as well as his presentation four years later when he was diagnosed with celiac disease. Nonetheless, his symptoms in both cases resolved with surgery and a gluten-free diet, respectively. The present case demonstrates an apparent five-year latency in the presentation of lymphocytic enterocolitis.
Lymphocytic colitis may be asymptomatic; two studies (1
) have shown a frequency rate of 0.9% for lymphocytic colitis in routine colonoscopic biopsies of asymptomatic patients. Therefore, it is conceivable that the prevalence of histopathological changes of lymphocytic colitis is higher once asymptomatic individuals are accounted for. The risk for latent disease may lower the threshold for taking biopsies during screening colonoscopy, especially for those with other autoimmune conditions such as celiac disease. It is also suggested that the association between drugs and lymphocytic colitis may be mediated by activation of a latent disease process.