PMC9906040_01
Colonoscopy revealed marked erythema, absent vascular pattern lesions extending from the rectum to the transverse colon which was compatible with Mayo 2.
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F1
One week before admission, he described his stools as more frequent, with 30-40 per day, small volume, bloody and tenesmus, while his colonoscopy displayed lesions extending to the transverse colon (shown in Fig. 1).
a Computed tomography scan on admission day showed diffuse, mild thickening of descending colon with endorsement of mesenteric veins. The small bowel and colon were full of air and fluids, with a maximum diameter of 8 cm. However, there are no signs of bowel obstruction. b Plain abdominal X-ray on day 3, before starting infliximab. c Plain abdominal X-ray on day 9, 6 day after the first dose of infliximab. d Plain abdominal X-ray after two accelerated infliximab doses.
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F2
Computed tomography of the abdomen with intravenous contrast material revealed air-filled small bowel and colon with 8 cm diameter (shown in Fig. 2a). A plain film radiograph of the abdomen showed severe transverse colon dilatation of 11 cm (shown in Fig. 2b). Six days after infliximab initiation, the hematochezia nearly disappeared, but his abdominal distension was intact (shown in Fig. 2c). One week following the second infliximab dose, both of his symptoms, inflammatory markers (CRP of 27 mg/L, white blood cell count of 7.41 G/L), and the dilatation of the transverse colon, significantly improved (shown in Fig. 2d).
Specimen biopsies demonstrated cryptitis, some crypt abscesses, and erosive epithelium (a), transverse colon (b), descending colon (c), sigmoid colon (d) revealed edema mucosa with severe lymphoid aggregates intermingling with neutrophils in the lamina propria (HE. x100). The intact figures (HE. x200) demonstrated dense basally between the lamina muscularis mucosa and crypt bases (basal plasmacytosis). A portion of submucosal specimens revealed less inflammation than those of mucosa. Either normal crypt or dysplasia was not represented in the biopsies of the left colon.
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F3
Clostridium difficile, were all negative based on stool studies. Cytomegalovirus inclusions were undetectable on colonic biopsy specimens 1 week prior to this admission (shown in Fig. 3a-d).
Colonoscopy showed healed mucosa with multiple pseudopolyps 1 year later.
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F4
One year later, his symptoms had been fully controlled and his colonoscopy revealed mucosa with Mayo 0, many pseudopolyps (shown in Fig. 4).