PMC5741136_01
Sharp area of demarcation with circumferentially ulcerated and sloughing mucosa.
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F1
CT was repeated. Colonoscopy showed circumferential ulcerated mucosa with grayish discoloration and sloughing of the mucosa starting at the hepatic flexure and extending proximally, potentially due to ischemic colitis (Figure 1).
Presence of pneumatosis intestinalis with persistent isolated right-colon ischemia.
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F2
Repeat abdominal CT showed persistent isolated right-colon ischemia with new pneumatosis intestinalis (Figure 2).
Colon resection specimen showing granulation tissue within ulcer base, important inflammatory infiltrate, and the presence of a CMV-infected cell (arrow) with characteristic owl's eye appearance (hematoxylin and eosin stain, 400x magnification).
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F3
On pathology, multiple CMV-infected cells were identified with ulcerations and perforation, consistent with severe CMV colitis (Figure 3).