PMC6914957_01
Rectal mucosal with ulcerations.
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fig1
Patient was admitted and colonoscopy performed to further identify the cause of rectal bleeding revealed diffusely erythematous, congested, friable rectal mucosa with two superficial ulcers (Figure 1).
Rectal biopsy showing diffuse expansion of lamina propria with infiltration by lymphohistiocytic cells. (H and E, magnification x200).
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fig2
Pathology for rectal biopsy revealed AFB positive organism (Figures 2 and 3) and culture revealed growth of Mycobacterium avium-intracellulare (MAI) organisms.
Rectal biopsy: acid fast staining showing sheets of macrophages packed with bundles of acid-fast bacilli, characteristic of Mycobacterium avium intracellulare. (Acid fast stain, magnification x400).
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fig3
Pathology for rectal biopsy revealed AFB positive organism (Figures 2 and 3) and culture revealed growth of Mycobacterium avium-intracellulare (MAI) organisms.
Liver biopsy with nonnecrotizing granuloma. Composed of lymphohistiocytic collections. (H and E, magnification x400).
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fig4
Pathology was reported to have necrotizing granulomas composed of lymphohistiocytic collections (Figure 4), highly suggestive of MAI infection.
Friable rectal mucosa with edema (2 months after initiation of MAI treatment).
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fig5
Patient was on and off the recommended regimen, flexible sigmoidoscopy after a short course of interrupted treatment again demonstrated similar initial findings in the rectum (Figure 5) but a follow up colonoscopy 20 months after diagnosis showed healing of rectal mucosa with negative biopsies for MAC.