Ulcerative colitis presenting with recurrent alternating bowel habits and rectal bleeding in a young female: a case report

Abstract

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that mostly affects the colon and rectum. The condition frequently causes symptoms such as diarrhoea, abdominal pain and rectal bleeding. Additionally, the delayed diagnosis is common because UC symptoms often mimic those of other conditions, such as haemorrhoids and IBS. This report underscores the need for timely diagnosis and intervention, based on clinical, endoscopic, and biomarker testing, including the use of fecal calprotectin. A 24-year-old female presented to her primary care provider with complaints of alternating bowel habits complaints, lower abdominal pain and rectal bleeding. She was initially misdiagnosed as having haemorrhoids and IBS with no systemic conditions suspected. Lab testing showed normal C-reactive protein (CRP <5 mg/l) and normal results on complete blood count (WBC 4.2 × 10⁹/l, haemoglobin 13.2 g/dl, platelets 250×10⁹/l, RBC 4.8×10¹²/l). Fecal calprotectin levels were notably high at 1035 µg/g; normal <50 µg/g). A colonoscopy revealed a diagnosis of distal proctitis that was classified as Mayo score 3. The first-line treatment included the use of mesalamine both orally and as a topical agent. Clinical improvement and reduced fecal calprotectin (34 µg/g) were reported during follow-up, reflecting gastrointestinal mucosal healing and a positive response to therapy. The usefulness of fecal calprotectin as a key biomarker in the evaluation of disease progression in UC is highlighted by this case. Appropriate diagnosis along with early mesalamine treatment contributed to symptoms relief and mucosal recovery. Immediate care is important in reducing complications and promoting patient recovery.