Gut Dysthymia: Paraneoplastic Chronic Watery Diarrhea

Excerpt

A 27-year-old East Asian woman with history of metastatic thymoma was evaluated for a 2-year history of non-bloody chronic watery diarrhea. As an outpatient, she had been evaluated on multiple occasions due to profuse, watery diarrhea that occurred seven times a day. She underwent colonoscopy after 6 months of symptoms, which was normal except for internal hemorrhoids. Computed tomography (CT) of the abdomen/pelvis demonstrated new diffuse circumferential wall thickening of the terminal ileum, cecum, and ascending colon. Stool studies for infectious agents were negative. Upper endoscopy and colonoscopy a month prior to presentation demonstrated possible colitis. Colon biopsies demonstrated crypt abscesses and cryptitis as well as neutrophilic infiltrates in the lamina propria. She was trialed on budesonide 9 mg daily without improvement. …