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case_images: (a) First colonoscopy: extensive ulceration of transverse colon with a granular appearance and a yellowish-white moss; (b) Follow-up colonoscopy: the ulcers were in remission, red erosion of the mucosal surface can be seen in the transverse colon; (c) Colonoscopy at this admission: extensive ulceration of transverse colon with a granular appearance, mucosa hyperemia and a yellowish-white moss.
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case_images: Colonoscopy demonstrated extensive ulceration of transverse colon with a granular appearance and a yellowish-white moss.(Figure 1a) However, pathology report at that time did not indicate any specific lesions. Follow-up colonoscopy showed the ulcers were in remission, red erosion of the mucosal surface can be seen in the transverse colon.(Figure 1b) Consequently, she discontinued mesalazine and thalidomide herself. Colonoscopy indicated aggravation of lesions, extensive ulceration of transverse colon with a granular appearance, mucosa hyperemia and a yellowish-white moss recurred.(Figure 1c) Pathology report showed chronic inflammation with inflammatory necrosis exudation and granulation tissue proliferation in the transverse colon, amyloid deposits around the mucosal stroma and small blood vessels can be seen, with positive Congo red staining.
case_images: Computed tomography(CT) images: (a) Chest CT scan showed a ground-glass nodule(4.2mm) in the upper lobe of the left lung; (b and c) The nodule was progressively enlarged during the follow-up two years(6.3mm to 9.3mm).
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case_images: During the follow-up two years, there was progressive enlargement of the pulmonary nodules.(Figure 2) After multidisciplinary consultation, surgical resection was recommended.
case_images: (a and b) Both Congo red staining of transverse colon biopsy specimen was positive.
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case_images: Reviewing the initial pathological sections of colon(three years ago), Congo red staining was also positive.(Figure 3) Based on these findings, a diagnosis of amyloidosis was considered, and she was referred to the hematology department for further treatment.