PMC6609337_01
CT, MR Imaging. (a) Coronal CT, irregular wall thickening of the TI (long orange arrow), and mild RLQ lymphadenopathy (short orange arrow). (b) MRE, wall thickening of TI (yellow arrow).
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Resonance Imaging (MRI) of the abdomen/pelvis showed a diffusely distended colon and dilated ileum concerning for ileus or enterocolitis, likely infectious or inflammatory in etiology (Figure 1). Rectal exam under anesthesia was notable for a functional narrowing of the anus and two large ulcers at the posterior anal canal.
Colonoscopy images. Extensive involvement of the terminal ileum with circumferential ulcerations and inflammation (left). Detailed view of erosions and inflammation seen throughout the ileum (right).
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Ileocolonoscopy performed under sedation and monitored anesthesia care demonstrated extensive circumferential ulcerations and inflammation of the terminal ileum (TI) with endoscopically normal colon (Figure 2).
Biopsies from terminal ileum. (a) 200x and 500x (inset) H&E stained appearance of CMV-infected cells. (b) 400x H&E stain showing a cell with CMV cytopathic effect. (c) 500x H&E stain showing a cell with another variation of CMV cytopathic effect. (d) 500x H&E stain with another example of CMV cytopathic effect. The nucleus contains a viral inclusion.
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Nearly all TI biopsies were positive for scattered CMV-infected cells in a background of diffuse histopathologic effect and ulceration (Figure 3).