ulcerative colitis

Paediatric inflammatory bowel disease (IBD) most usually evolves during adolescence, a time of great challenge. For the adolescent, the disease should be thoroughly assessed by upper gastrointestinal endoscopy and ileo-colonoscopy, preferably performed under general anaesthetic or conscious sedation, with relevant radiological examination. This will enable the determination of diagnosis, IBD subtype and extent. Growth also needs to be assessed and the effect of disease on academic and social functioning must be explored.

Cytomegalovirus (CMV) colitis is rarely reported in the immunocompetent adult and is often associated with inflammatory bowel disease (IBD), particularly ulcerative colitis (UC). An index of suspicion in the appropriate setting is vital to diagnosing the condition. Undiagnosed CMV colitis has a significant morbidity. A review of the natural history and diagnosis of CMV is followed by a discussion of the incidence, outcome and possible treatment of CMV in the immunocompetent patient.

We report a case of unilateral eosinophilic pneumonia secondary to balsalazide monotherapy for ulcerative colitis. After commencing balsalazide, the patient presented with a history of cough, progressive dyspnoea and lethargy. Blood counts revealed peripheral eosinophilia. Her chest radiograph showed leftsided infiltration, and high-resolution computerised tomography demonstrated widespread nodular shadowing and ground glass opacifiction in the left lung. The right lung was normal. Transbronchial lung biopsy confirmed eosinophilic pneumonia.