PMC8188031_01
Endoscopic findings. A) Small villous polyposis throughout the lower gastrointestinal tract. B) Numerous inflammatory polyps proliferating in the lining of the stomach.
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Repeated colonoscopy and esophagogastroduodenoscopy revealed an edematous and reddish mucosa and numerous polypoid lesions (Fig. 1).
Bone marrow examination findings. May-Grunwald Giemsa staining of a bone marrow smear. Hypoplastic marrow without proliferation of immature hematopoietic cells. No dysplasia is seen. Magnification, x40 (A), x400 (B).
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A bone marrow examination revealed hypoplastic marrow with no signs of hematological malignancy, such as leukemia or myelodysplastic syndrome (Fig. 2).
MRI findings of the spine. MRI of the spine reveals hyperintensity of the bone marrow on both T1- and T2-weighted imaging. The hyperintense region is hypointense on short-tau inversion recovery MRI.
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T2-weighted MRI of the spine showed mainly high signal intensity (SI) areas. These areas were depicted as low SI on short-tau inversion recovery (STIR) imaging, suggesting that the bone marrow had been completely replaced by fat (Fig. 3). Taken together, these findings led to a diagnosis of moderate AA that does not require a blood transfusion at all.
Clinical course. Due to the progressive thrombocytopenia and mild anemia, mesalazine was discontinued. Cyclosporine was initiated, and the platelets recovered with transient platelet transfusions. PSL: prednisolone, CsA: cyclosporine, PC: platelet concentrate, EPAG: eltrombopag, Neutro: neutrophils, Hb: hemoglobin, Reti: reticulocytes
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The clinical course is shown in Fig. 4.