case_images: PMC6609337_01
case_images: CT, MR Imaging. (a) Coronal CT, irregular wall thickening of the TI (long orange arrow), and mild RLQ lymphadenopathy (short orange arrow). (b) MRE, wall thickening of TI (yellow arrow).
case_images: CRIGM2019-4513795.001.jpg
case_images: PMC6609337_01_CRIGM2019-4513795.001.jpg
case_images: fig1
case_images: Resonance Imaging (MRI) of the abdomen/pelvis showed a diffusely distended colon and dilated ileum concerning for ileus or enterocolitis, likely infectious or inflammatory in etiology (Figure 1). Rectal exam under anesthesia was notable for a functional narrowing of the anus and two large ulcers at the posterior anal canal.
case_images: Colonoscopy images. Extensive involvement of the terminal ileum with circumferential ulcerations and inflammation (left). Detailed view of erosions and inflammation seen throughout the ileum (right).
case_images: CRIGM2019-4513795.002.jpg
case_images: PMC6609337_01_CRIGM2019-4513795.002.jpg
case_images: fig2
case_images: Ileocolonoscopy performed under sedation and monitored anesthesia care demonstrated extensive circumferential ulcerations and inflammation of the terminal ileum (TI) with endoscopically normal colon (Figure 2).
case_images: Biopsies from terminal ileum. (a) 200x and 500x (inset) H&E stained appearance of CMV-infected cells. (b) 400x H&E stain showing a cell with CMV cytopathic effect. (c) 500x H&E stain showing a cell with another variation of CMV cytopathic effect. (d) 500x H&E stain with another example of CMV cytopathic effect. The nucleus contains a viral inclusion.
case_images: CRIGM2019-4513795.003.jpg
case_images: PMC6609337_01_CRIGM2019-4513795.003.jpg
case_images: fig3
case_images: Nearly all TI biopsies were positive for scattered CMV-infected cells in a background of diffuse histopathologic effect and ulceration (Figure 3).