PMC5394402_01
Posteroanterior chest X-ray demonstrating extensive ill-defined bilateral parenchymal opacities in the perihilar, mid, and lower lung zones.
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A chest X-ray revealed extensive ill-defined bilateral parenchymal opacities in the perihilar, mid, and lower lung zones (Figure 1).
First colonoscopy: extensive diverticulosis and solitary ulcer in the sigmoid colon.
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It also demonstrated an ulcer in the sigmoid colon which was biopsied (Figure 2).
Second colonoscopy: (a) cecal ulcer and (b) transverse colon ulcer.
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A repeat urgent colonoscopy revealed multiple ulcers at the anus and transverse and ascending colon as well as the cecum; the terminal ileum appeared normal (Figure 3).
CT chest with IV contrast taken on day 13. (a) shows right upper lobe cavitary lesion. (b) shows multilobar consolidation.
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These findings were suspicious for atypical infection (Figure 4).
(a) 20x hematoxylin and eosin (H&E) stain demonstrating active colitis with crypt abscess and an ill-defined defined granulomatous area. (b) 40x AFB stain of the splenic flexure with necrotizing granuloma and acid-fast bacilli (circled).
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AFB stain of the sigmoid ulcer biopsy was positive with findings consistent with mycobacterium (Figure 5).