An unusual cause of diarrhea: Phlebosclerotic colitis

A 47-year-old man presented with a 2-month history of diarrhea, abdominal distension, and bilateral lower extremity edema. He had been previously diagnosed with hepatitis B treated with more than 10 species of Chinese herbal medicines (gardenia, rehmanniae radix, ophiopogon japonicus, adenophorae radix, etc) for 14 years. Physical examination revealed slight scleral icterus, distended abdomen with shifting dullness and dark bronze-colored skin with periocular skin predominance (Fig. 1A). Laboratory investigations demonstrated hypoalbuminemia (30 g/L, reference range 40-55 g/L), hyperbilirubinemia (TBIL: 56.1 µmol/L, reference range 0-26 µmol/L), proteinuria, and hematuria. Colonoscopy showed the total colon with mucosal edema, erosions, and dark bronze-colored surface (Fig. 1B). Histological examination revealed obviously thickened and hyaline change of vascular walls (Fig. 2, arrows), as well as interstitial fibrosis in lamina propria. Abdominal computed tomography scan indicated thickening of the whole colon and characteristic linear calcifications of the small mesenteric veins along the colonic wall (Fig. 3A). Additionally, computed tomography angiography at portal phase disclosed diffuse thread-like calcifications in the superior mesenteric vein, inferior mesenteric vein, and their branches clearly (Fig. 3B). Any arteries and veins of other organs in abdominal cavity had no obvious calcification. Based on these findings, we diagnosed him with phlebosclerotic colitis and liver cirrhosis.