PMC9124143_01
Colonoscopy: ulcerations and polyps in the ileocecal region and ascending colon.
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An urgent colonoscopy performed to evaluate hematochezia revealed segmental inflammation of the ascending colon with ulcerations and polyps covered with yellowish exudate, a distended ileocecal junction, and an aberrant vascular pattern with mucosal edema extending to the hepatic flexure (Figure 1).
CT chest axial image showing bilateral lung consolidations.
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In view of her respiratory complaints and accompanying systemic symptoms, a computed tomography (CT) of the chest and abdomen was performed, which demonstrated right lung consolidation, focal subsegmental consolidations in the left lung, and subcentimeter-sized lymph nodes in the small bowel mesentery (Figure 2).
Colonic biopsies. (a) Lamina propria shows expansion by inflammatory cells. A lymphoid aggregate (red asterix), nonneoplastic colonic glands (red dashed arrow), and granuloma are seen (yellow dashed line) (hematoxylin and eosin, original magnification x100). (b) Goblet mucin component decreased as well as cryptitis. Edge of granuloma is seen here (original magnification x200). (c) Acid-fast bacilli (black arrows) (Ziehl-Neelsen stain).
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Biopsies of the samples obtained during colonoscopy revealed lymphocytic infiltration, necrotizing granulomas, and positivity for AFB (Figure 3).