PMC7098339_01
The clinical course of the patient. The bar on the bottom indicates the stool quality. mPSL, methylprednisolone; PSL, prednisolone; GCV, ganciclovir; CMV, cytomegalovirus; SF, sigmoidoscopy; CS, colonoscopy; TCS, total colonoscopy; VCE, video capsule endoscopy; DBE, double balloon enteroscopy.
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F1
For this reason, ipilimumab therapy was discontinued; 4 weeks after the last infusion of ipilimumab, he developed grade 2 diarrhea that persisted for 10 days (Fig. 1).
Endoscopic and histologic findings. a Sigmoidoscopy before methylprednisolone therapy showed easy bleeding and coarse mucosa in the rectum. b Sigmoidoscopy on the 6th hospitalization day demonstrated almost normal rectal mucosa. c Colonoscopy on the 12th day showed multiple punched-out ulcers in the descending colon. d Histologic examination of the ulcers showed crypt abscess and inflammatory cell infiltration (hematoxylin and eosin staining). Original magnification, x4. Scale bar, 200 mum. e Immunohistochemistry for cytomegalovirus was positive. Original magnification, x40. Scale bar, 20 mum. f Double balloon enteroscopy demonstrated multiple ulcers in the small intestine.
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F2
Sigmoidoscopy confirmed signs of inflammation, with coarse mucosa that was easily bleeding and contained purulence and erosions; these endoscopic findings resembled ulcerative colitis (Fig. 2a). On the 6th day after hospitalization, sigmoidoscopy showed mucosal healing in the rectum (Fig. 2b). To confirm the source of bleeding, left-sided colonoscopy was performed on the 12th day after hospitalization and revealed multiple punched-out ulcers in the descending colon, but the remission in the sigmoid colon and rectum was maintained (Fig. 2c). Histologic examination of the biopsy samples from the ulcers showed crypt abscesses and infiltration of lymphocytes and plasma cells (Fig. 2d). Immunohistochemical study was positive for CMV (Fig. 2e), although CMV pp65 antigenemia was negative. On the 36th day after hospitalization, double balloon enteroscopy showed ulcers with healing tendency in the ileum (Fig. 2f).