PMC6016156_01
Upper digestive endoscopy showing an irregular ulcer with raised edges, fibrinolytic background, measuring approximately 3 cm in the middle third of the esophagus and 30 cm from the incisors and mild antrum gastritis.
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The medical team requested upper digestive endoscopy (Figure 1) and colonoscopy (Figure 2), which verified the presence of ulcer with irregular and raised edges, fibrinonecrotic base, measuring approximately 3 cm in the middle third of the esophagus and 30 cm from the incisors and the mild antrum gastritis, and swollen, irregular, and fibrinous ulcers in the ileocecal valve, descending colon, and all other segments.
Colonoscopy showing ulcers with raised and irregular borders and necrotic background measuring between 1.5 and 2 cm and flat erosions.
CRIM2018-8047892.002.jpg
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The medical team requested upper digestive endoscopy (Figure 1) and colonoscopy (Figure 2), which verified the presence of ulcer with irregular and raised edges, fibrinonecrotic base, measuring approximately 3 cm in the middle third of the esophagus and 30 cm from the incisors and the mild antrum gastritis, and swollen, irregular, and fibrinous ulcers in the ileocecal valve, descending colon, and all other segments.
Esophagus (a, d), ileocecal valve (b, e), and colon (c, f). Histopathological examination showing chronic granulomatous inflammation with necrotic area and giant cells, at 200x magnification (a, b, and c), in addition to alcohol-acid-resistant bacilli by Ziehl-Neelsen staining, at 400x magnification (e). (d, f) The immunohistochemical study with positive labeling for CMV in cells with clear halos, at 400x magnification.
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The diagnosis of tuberculosis and cytomegalovirus coinfection of the gastrointestinal tract was confirmed by the histopathological report (Ziehl-Neelsen staining of acid-fast bacilli, CMV intracytoplasmic inclusions in Giemsa staining, and immunohistochemical study with positive labeling for CMV in cells with clear halos), and some time later, culture with the growth of M. tuberculosis (Figure 3).