PMC6375019_01
(a) Positron emission tomography-computed tomography scan showing fluorodeoxyglucose uptake in distal ileum, (b) ileal biopsy showing confluent granulomas with epithelioid cells and multinucleated Langhans giant cells (H and E, x20), (c) Ziehl-Neelsen stain of the ileal tissue showing acid-fast bacilli
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F1
Whole-body positron emission tomography-CT (PET-CT) was done which showed a lesion with high fluorodeoxyglucose uptake in the terminal ileum [Figure 1a] and mesenteric lymph nodes. Lymph node biopsy showed necrosis with noncaseating granuloma containing Langhans giant cells [Figure 1b], and biopsy from the ileal mucosa showed multiple discrete and large nonconfluent granulomas composed of epithelioid histiocytes and multinucleated giant cells; some of the granulomas showed central suppuration [Figure 1c].
(a-c) Kidney biopsy showing (a) cortical necrosis (H and E, x20), (b) partial necrosis of large caliber blood vessel - white arrow, (H and E, x10), (c) fibrinoid necrosis of the vessel wall - black arrow, (Masson's trichrome, x40)
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F2
In view of nonrecovery of renal function after 2 weeks, renal biopsy was done, which showed patchy cortical necrosis with fibrinoid necrosis of the medium-sized arteries [Figure 2a-c].