PMC6419258_01
Ultrasonographic appearance of the jejunum (arrowhead) and ascending colon on a transverse section revealing increased wall thickness to 4.8 mm (arrow)
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Ultrasonography revealed moderately increased intestinal wall thickness (4.8 mm) from the ascending to proximal descending colon (Figure 1).
Endoscopic image of the transverse colon. Multiple haemorrhagic lesions are apparent in the friable mucous membrane
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Endoscopic examination revealed partial circumferential narrowing of the transverse colon and friable colonic mucosa with multiple haemorrhagic regions (Figure 2).
Colon. Lower magnification reveals thickening of the colonic wall. Marked ulceration of the colonic mucosa and distortion of the glandular architecture in the lamina propria are identified. Haematoxylin and eosin
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Histological examination with haematoxylin and eosin staining (HE) revealed marked ulceration of the colonic mucosa; marked alteration in the normal glandular architecture was observed in the lamina propria (Figure 3).
Colon. Marked transmural infiltration of foamy macrophages (arrow) is accompanied by neutrophils, plasma cells and lymphocytes
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The lesions consisted of marked transmural infiltration of foamy macrophages accompanied by neutrophils, plasma cells and lymphocytes (Figure 4).
Colon. Infiltration of periodic acid-Schiff stain-positive macrophages in the lamina propria
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The infiltrating macrophages were predominantly periodic acid-Schiff (PAS) positive (Figure 5).
Colon. Colonisation of bacilli is identified in the granulomatous lesion. Warthin-Starry stain
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Warthin-Starry, Ziehl-Neelsen and gram stains identified intracytoplasmic non-acid-fast, gram-negative bacilli in the macrophages on tissue section (Figure 6).
Colon. Numerous bacilli are identified in the colonic lamina propria. Immunohistochemistry for Escherichia coli lipopolysaccharide
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Iba-1+ macrophages and colonisation of E coli in the granulomatous lesions (Figure 7). In view of these findings, a final diagnosis of GC was made at day 21.