A 23-year old woman, presented with progressive abdominal pain and diarrhea for 6 months. During the time, she was treated with a decocted Chinese herbal medicine for 1 month.
On colonoscopy, diffusive black spots from cecum to the sigmoid colon were found (Fig. 1A, white light). The micro-vessels around the black spots were dilated and interrupted (Fig. 1B, magnified NBI).
Focal crypt abscess, chronic hemorrhagic necrosis, hemosiderin and phagocytes were seen in epithelium. Inflammatory cell infiltrated into the lamina propria, dominated by lymphocytes and plasma cells. Vascular obstruction and remote hemorrhage could be seen (Fig. 1 C, as described in this paragraph).
This patient was diagnosed as drug-induced ischemic colitis1 accompanied with ulcerative colitis (UC).
The herbal medicine was discontinued. UC was treated with mesalazine. The abdominal pain and bloody diarrhea were alleviated.
Surveillance colonoscopy 3 months later showed a basically normal mucosa with rare black spots (Fig. 1D, images from surveillance colonoscopy). Pathological examination showed fewer focal crypt abscess and vasculitis, as well as a decline of lymphocyte (Fig. 1E, pathological results after treatment).
FundingAll authors declare no funding on this work.
Conflict of interestAll authors declare no conflict of interest.
