Answer to the last #DiagnosticDilemma
The correct answer is C, Infectious colitis

Infectious colitis manifesting as bloody diarrhea is generally acute in onset, appearing within 1 week of contracting the infection. These patients will have grossly bloody stool that takes the shape of its container. Although grossly bloody stool can be alarming, the amount of bleeding usually does not cause significant hemoglobin reductions. Exposure history, such as travel, water, and sick contacts, can be helpful in establishing the diagnosis.

Colorectal cancer is unlikely in this case because of the abrupt symptom onset and lack of significant risk factors. Generally, colorectal cancer manifests as microscopic, low-volume, or obscure blood loss in normal or small-caliber stool. Hematochezia in colorectal cancer is uncommon. Diverticular bleeding is the most common cause of hematochezia overall, but it tends to occur in older patients and is typically isolated without pain or diarrhea.

Inflammatory bowel disease (IBD), such as ulcerative colitis or Crohn disease, can manifest with grossly bloody diarrhea as well. These patients tend to exhibit weight loss, iron deficiency anemia, and chronic bowel habit changes. Ischemic colitis mostly occurs in individuals older than 60 years.

This patient does not meet criteria for empiric antibiotic or symptomatic therapy, the best next step in treatment is to provide supportive therapy in the form of oral hydration to replace fluid losses, analgesics such as acetaminophen, and fever control, all while awaiting the results of testing. The patient was instructed to continue oral hydration and discontinue the loperamide that he had been taking.

The question for this diagnostic dilemma can be read here: https://www.plexusmd.com/md/post?pfpid=47723

To know more about this case: https://www.mayoclinicproceedings.org/article/S0025-6196(19)30391-X/fulltext?rss=yes
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