PMC5498195_01
Total colonoscopy in the patient of the present study showed mucosal roughness and the loss of the mucosal vascular appearance progressing from the rectum to the ascending colon. The results were compatible with UC. The terminal ileum was negative for these findings. This patient was pretreated with only a glycerin enema. A: terminal ileum, B: ascending colon, C: transverse colon, D: descending colon, E: sigmoid colon, F: rectum.
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Total colonoscopy before GMA showed mucosal roughness and the loss of the mucosal vascular appearance, progressing from the rectum to the ascending colon (Fig. 1).
The rectal examination of the patient of the present study, showed rough hemorrhagic mucosal changes with multiple erosions.
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A rectal examination showed rough hemorrhagic mucosal changes with multiple erosions; however, deep ulceration was not observed (Fig. 2).
The clinical course of the patient at his local hospital. The day the patient was transferred to our hospital was defined as day 0.
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Moreover, his platelet counts decreased to 7.9x104/muL on day -29 this was followed by further subsequent reductions (Fig. 3).
Axial and coronal chest CT, showing mediastinal air around the trachea and bronchus.
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Chest computed tomography (CT) revealed pneumomediastinum (Fig. 4), and abdominal CT revealed slight all-around thickening of the entire large intestine, except for the ileocecum (Fig. 5).
A bone marrow scan of the patient of the present study showing (A) a large number of aggregated megakaryocytes (x200) and (B) the absence of platelet adhesion around the megakaryocytes (x1,000).
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His platelet-associated IgG (PAIgG) level was 480.5 ng/107 cells (normal range, 5.0-25.0 ng/107 cells), and a bone marrow examination revealed normocellular marrow with increased numbers of megakaryocytes (Fig. 6).
A rectal examination, showed improvements in the mucosa along with reductions in the rough hemorrhagic mucosal changes.
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His UC activity decreased immediately with the disappearance of hematochezia and abdominal pain (Fig. 7), and his platelet counts gradually increased, resulting in a dramatic improvement in his general condition.
Chest CT showing that the mediastinal air had disappeared.
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Ceftriaxone, which had been started at his local hospital, was discontinued on the 8th day after admission to our hospital because his CRP level had decreased, and chest CT showed the disappearance of mediastinal air (Fig. 8).