PMC3662170_01
Acute colitis in the ascending and transverse colon.
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fig1
CT scan demonstrated acute colitis in the ascending and partial transverse colon (Figure 1).
Mucosal edema with friability and ulceration on colonoscopy.
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The patient underwent a colonoscopy on hospital day 2 which revealed multiple diverticuli, evidence of mucosal edema with friability and ulceration from the transverse colon to sigmoid colon (Figure 2).
Colonic biopsy at medium magnification (100x, H&E stain) showing features characteristic of ischemic injury, including crypt atrophy, loss of cytoplasmic mucin, nuclear hyperchromasia, and absence or shedding of the luminal surface epithelium.
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fig3
Her colonic biopsies came back and were consistent with ischemic colitis (Figure 3).
Peripheral blood (Wright Stain, 1000x) showing schistocytes, characteristic of microangiopathic hemolytic anemia.
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fig4
Schistocytes were observed on the peripheral smear and bone marrow biopsy. (Figure 4) Her omeprazole was discontinued, steroids were started, and the patient underwent therapeutic plasmapheresis with plasma exchange.