PMC8572864_01
Colonoscopy imaging of the cecum. (a) An ulcer with pus-like deposits in the cecum revealed by colonoscopy at BLD diagnosis. (b) An ulcer scar in the cecum after initial immunosuppressive therapies. (c) Multiple recurrent ulcers in the ileum after one cycle of azacitidine therapy. (d) A hemorrhagic ulcer in the ileum on 3 days after BMT. (e) An ulcer with blood clots in the ileum on 32 days after BMT. (f) An ulcer scar in the ileum on one year after BMT.
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A colonoscopy revealed multiple small ulcers in the entire colon, especially in the distal to ascending colon, and a part of the ulcers had pus-like deposits (Fig. 1a). Her symptoms did not recur following PSL taper, and follow-up colonoscopy at 5 months after diagnosis revealed only ulcer scars (Fig. 1b). Adverse Events (CTCAE) followed by febrile neutropenia. A colonoscopy revealed multiple recurrent ulcers and diffusely edematous intestinal mucosa (Fig. 1c). As the recurrent BLD, the dosage of PSL was increased by 15 mg, and cyclosporine was started at a dose of 3 mg/kg orally. An emergency colonoscopy identified a deep ulcer with adherent blood clots in the farther position of the ileum that had not been observed before allo-HSCT (Fig. 1d). Furthermore, a colonoscopic examination on day 32 after allo-HSCT revealed an ulcer with blood clots at the same location, but no active bleeding was observed (Fig. 1e). Colonoscopy at 1 year after BMT revealed only ulcer scars (Fig. 1f), and all BD-like symptoms had completely disappeared at that time.
Histopathological images of ulcer lesions in the cecum at BLD diagnosis. (a ,b) Hematoxylin and eosin staining of the ulcer lesion. Nonspecific inflammatory changes with infiltration of neutrophils, lymphocytes, and plasmacytes are observed in the submucosal layer. Black arrows indicate neutrophils. A: low power magnification; B: high power magnification. (c) FISH analysis of the specimen of the ulcer lesion with DAPI staining and green-labeled chromosome 8 centromere probe. Only a few trisomy 8-positive cells are scattered in the submucosal layer. White arrows indicate trisomy 8-positive cells.
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Pathologic examination of the ulcer showed nonspecific inflammatory cell infiltration, mainly composed of lymphocytes and plasma cells (Fig. 2a, b). Finally, sporadic trisomy 8-positive cells were noticed by fluorescence in situ hybridization (FISH) analysis (Fig. 2c).