PMC5968150_01
Computed tomography showing thickening of sigmoid colon and rectum (arrow).
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F1
Abdominal computed tomography (CT) revealed nodular thickening of the small bowel and circumferential thickening of the rectum, sigmoid, and descending colon, which were unchanged from an abdominal CT done 2 months prior (Figure 1).
(A) Hematoxylin and eosin stain showing enlarged endothelial cells (arrows) with intracytoplasmic and nuclear inclusions. (B) Immunohistochemistry showing cytomegalovirus (arrow).
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F2
Biopsies obtained from the center and margins of the ulcer, as well as from random colonic mucosa, demonstrated tissue CMV, and the patient was started on intravenous foscarnet (Figure 2).
Repeat colonoscopy showing (A) a large ulcer on the ileocecal valve with active bleeding and an overlying clot, and (B) a visible vessel at the margin of the ulcer.
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F3
At repeat colonoscopy, a large clot was noted along with a bleeding visible vessel on the margin of the previously treated and biopsied ulcer (Figure 3).
Successful application of an endoscopic clip for hemostasis.
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F4
Epinephrine was injected, and an endoscopic clip was applied with successful hemostasis (Figure 4).