PMC3921955_01
(a) CT scan in December 2009; thickening of small intestine wall is circled. (b) Contrast-enhanced CT scan in February 2010; edema-like contrast effect of intestinal wall thickening is circled.
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fig1
A computerized tomography (CT) abdominal scan revealed intermittent (full thickness) thickening of the small intestinal wall (Figure 1(a)). Two months later, in February 2010, a follow-up, contrast-enhanced CT scan showed a different distribution of intestinal thickening, with an edema-like contrast effect seen in the thickened intestinal tract (Figure 1(b)).
Clinical course from December 2009 to January 2011. (a) C-reactive protein, lactate dehydrogenase, and D-dimer levels. (b) Hemoglobin and platelet levels.
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fig2
Routine assessments of hemoglobin, CRP, platelets, D-dimer, and LDH were collected over this period and are plotted along with the occurrence of abdominal pain in Figure 2(a). From Figure 2(a), it can be seen that the periods of abdominal pain were clearly associated with increases in CRP and D-dimer, indicators of inflammation and thrombosis, respectively. The abdominal pain was also associated with peaks in LDH concentrations, which were generally 4-fold higher than the ULN, as well as decreases in levels of hemoglobin and platelets (Figure 2(b)). The initiation of treatment coincided with the beginning of a period of abdominal pain which, by the following day, had resolved (Figures 2(a) and 2(b)). By the end of the first 3 weeks of eculizumab treatment, the abdominal pain and enteritis had completely resolved, levels of CRP had fallen to zero, LDH concentration and D-dimer were within the normal range (Figure 2(a)), and levels of platelets and hemoglobin were increasing (Figure 2(b)).