Fulminant amebic colitis in a patient with concomitant cytomegalovirus infection after systemic steroid therapy: A case report

Figure 1 Chest radiography of a 68-year-old man with chest pain and acute dyspnea on admission. Chest radiography showing consolidation in the right upper lobe (arrow) and bilateral congestion.

Figure 2 Colonoscopic and histopathological findings in a 68-year-old man who developed bloody diarrhea under glucocorticoid therapy. A: Colonoscopy showing multiple large ulcers in the sigmoid colon (arrow) and active colitis throughout the colon; B: Colonoscopy also showing multiple large ulcers in the rectum (arrow); C: Neutrophilic and lymphocytic infiltration of the sigmoid colon’s mucosal interstitium (hematoxylin and eosin stain, × 20); D: Intranuclear inclusions of cytomegalovirus detected on immunohistochemical examination of the sigmoid colon’s interstitium (arrow, × 20).

Figure 3 Macroscopic and histopathological findings during autopsy of a 68-year-old man who died after intestinal perforation. A: Macroscopic findings revealing transmural intestinal necrosis and a “ragged appearance” in the rectum, descending colon, and sigmoid colon; B: Histopathological findings showing full-thickness necrosis of the intestinal wall from the mucosa to the serosa. Furthermore, severe infiltration of the necrotic tissue with ameba is visible (hematoxylin and eosin stain, × 4); C: A few intranuclear cytomegalovirus inclusions can be detected on immunohistochemical examination of the sigmoid colon (arrow, × 40); D: Entamoeba histolytica trophozoites are visible in the submucosa (periodic acid–Schiff stain, arrow, × 20).