GIANT-CELL VASCULITIS AND MICROSCOPIC (COLLAGENOUS-LYMPHOCYTIC) COLITIS

A 55-year-old female with watery diarrhea over 20 years was found to h ave microscopic (collagenous) colitis in 1986. During her subsequent c linical course, colonic biopsies revealed typical pathological feature s of both lymphocytic and collagenous colitis. The patient developed f ever, malaise, headache, multiple vascular bruits and an elevated sedi mentation rate. Although a large vessel vasculitis was suspected, biop sy of the temporal artery was normal. Subsequent arch aortography and selective arterial catheterization studies revealed multiple vascular stenoses and occlusions; despite its very atypical clinical presentati on, a biopsy of an occluded brachial artery revealed characteristic fe atures of giant cell ateritis. Steroid therapy resulted in prompt clin ical remission. The clinical spectrum of findings in this patient furt her supports the concept that collagenous colitis and, possibly, other histologically related forms of microscopic colitis, such as lymphocy tic colitis, may be pathological markers of a more generalized immunol ogic disorder.