Herrera et al described a unique form of colitis that develops in patients who have received a stem cell transplant using cord blood. The authors are from Brigham and Women's Hospital, Dana-Farber Cancer Center and Massachusetts General Hospital.
Clinical features:
(1) history of umbilical cord derived stem cell transplant
(2) onset of a persistent diarrhea lasting > 7 days
(3) remission with continuous antibiotic therapy
(4) relapse on discontinuation of antibiotic therapy
(5) exclusion of other causes for the diarrhea
The diarrhea:
(1) is usually watery
(2) is usually nonbloody
(3) may be associated with fever
(4) may be associated with weight loss
Most patients have resolution of diarrhea with metronidazole and fluoroquinolone, with recurrence on discontinuation of therapy.
A colon biopsy shows chronic active colitis with or without granulomatous inflammation.
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