PMC8371233_01
Contrast-enhanced CT scan of the abdomen showed diffuse thickening of small and large bowel walls with surrounding peri-intestinal fat stranding (Fig. 1A). Sigmoidoscopy showed diffuse markedly edematous mucosa covered by yellowish exudates along the rectum and sigmoid colon (1B). Colonic biopsy, hematoxylin-eosin staining, showed acute inflammation and ulceration with CMV-related cytopathic changes (cytomegaly, intranuclear and intracytoplasmic inclusion bodies, and peripheral margination of chromatin) involving stromal cells in granulation tissue (Fig. 1C and D).
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Clostridium difficile and stool bacterial culture were negative. Contrast-enhanced CT scan of the abdomen revealed diffuse thickening of small and large bowel walls with surrounding peri-intestinal fat stranding (Fig. 1A). Sigmoidoscopy was performed and showed diffuse markedly edematous colonic mucosa covered with yellowish exudates along the rectum and sigmoid colon (Fig. 1B). Colonic biopsy was performed and showed acute inflammation and ulcerartion with Cytomegalovirus (CMV)-related cytopathic changes (cytomegaly, intranuclear and intracytoplasmic inclusion bodies, and peripheral margination of chromatin) involving stromal cells in granulation tissue (Fig. 1C and D).
The spontaneously-excreted small intestinal cast (Fig. 2A) and colonic cast (Fig. 2B and C).
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During the antiviral treatment, she spontaneously excreted small intestinal casts, a tubular-shaped infarcted bowel wall segment, per oral (Fig. 2A) and colonic casts per anus, measured 40-60 cm in length (Fig. 2B and C).
Histological examination of the intestinal casts, hematoxylin-eosin staining, showed necrotic debris, fibrin and degenerated tissue (Fig. 3A and B).
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Histological examination of the intestinal casts showed necrotic debris, fibrin and degenerated tissue (Fig. 3A and B).