Apoptotic colopathy in a pediatric autologous bone marrow transplantation patient with spontaneous colonic cast excretion: Is it due to GVHD or rotavirus infection?

Abstract

Spontaneous colonic cast excretion per anus is a very rare entity. Colonic ischemia and severe infections are the most common etiologic factors. It is mostly seen in adults. Only one pediatric patient with colonic cast excretion was reported in the literature. We present a three-year-old male patient with the diagnosis of neuroblastoma who had undergone autologous BMT. After suffering a prolonged rotavirus infection, on the 25th the post-transplantation day, he presented with nausea, vomiting, abdominal pain, and spontaneous excretion of colonic mucosa-like material via defecation. The histopathological interpretation of the excreted material revealed acellular material composed of fibrin and neutrophils. The patient’s colonoscopic biopsy specimen revealed crypt distortion, regeneration, and numerous apoptotic bodies within the crypt epithelium. Apoptotic colopathy and colonic cast excretion per anus is a sign of ischemia, which may be caused by severe intestinal infections or rarely, graft-versus-host disease. Therefore, a clinicopathological correlation was performed to reach a definitive diagnosis. The patient’s symptoms were attributed to severe, prolonged rotavirus infection.