PMC3843920_01
Images recorded at the initial visit. a Lower gastrointestinal endoscopy showing mucosal petechiae in the descending colon. b Computed tomography of the abdomen showing slight thickening of the descending colonic wall.
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F1
Lower gastrointestinal endoscopy showed mucosal petechiae in the descending colon, and the patient was believed to have colitis caused by fecal impaction (fig. 1).
Pre-therapy and follow-up endoscopic images. Pre-therapy images: a Esophagus. Necrosis of the entire mucosa in the lower esophagus. b Stomach. Linear erosions from the antrum to the body. c Duodenum. Multiple duodenal ulcers in the bulbus. d Descending colon. Necrosis of the entire mucosa with sloughing. Follow-up images: e Esophagus. Mucosal necrosis is improved, but the stenosis remains. f Stomach. No signs of mucosal injury. g Duodenum. Ulcers tending to heal. h Descending colon. Mucosal necrosis is improved, but the stenosis remains.
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F2
Lower gastrointestinal endoscopy was performed again, and mucosal necrosis with sloughing was observed along the entire circumference of the descending colon (fig. 2a-d). The patient resumed oral intake 30 days after her first visit but had developed cicatricial stricture of the esophagus and colon (fig. 2e-h).
Clinical course of the patient. CTRX = Ceftriaxone; MEPM = meropenem; VCM = vancomycin; G-CSF = granulocyte colony-stimulating factor; rTM = recombinant human soluble thrombomodulin; LV = leucovorin; IVIG = intravenous immunoglobulin; PC = platelet concentrate; RCC = red cell concentrate; PMX = polymyxin B-immobilized fibers; CHDF = continuous hemodiafiltration.
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F3
She was discharged from our hospital 15 weeks after admission (fig. 3).