PMC3999574_01
Sigmoidoscopy showing erythematous mucosa with ulceration in the sigmoid (a), descending colon, splenic flexure (b) and proximal transverse colon (c).
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F1
Flexible sigmoidoscopy revealed a segmental erythematous mucosa and multiple ulcers in the sigmoid colon, descending colon, splenic flexure and proximal transverse colon, suggesting a mucosal injury pattern consistent with ischemic colitis (fig. 1).
a The colonic mucosa showed abnormal architecture with unevenly spaced and distorted crypts, features likened to changes seen in inflammatory bowel disease. A withered crypt composed of epithelial cells with eosinophilic change was present (arrow). Hematoxylin and eosin, original magnification 200x. b Individual dilated, damaged crypts were present, scattered throughout the mucosa (arrows). Note the cytoplasmic eosinophilic change and the luminal debris. Hematoxylin and eosin, original magnification 400x. c Subtle background apoptotic bodies (arrows) were present in increased numbers, indicating cellular injury and turnover. Hematoxylin and eosin, original magnification 400x.
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F2
However, biopsies showed dilated damaged crypts, eosinophilic epithelial changes and crypt abscesses with apoptotic bodies, a pattern of injury highly suggestive of MMF-related colitis (fig. 2).