Clinical presentation

A 67-year-old woman presented with a 6-week history of progressive abdominal distension. Her clinical examination revealed a palpable pelvic mass. She underwent total abdominal hysterectomy, salpingo-oophorectomy and removal of a 3 kg ovarian cystadenoma. Postoperatively she had renal impairment; urine microscopy revealed red cell casts and renal biopsy demonstrated a segmental crescentic necrotising glomerulonephritis. This was successfully treated with pulsed steroids and cyclophosphamide. Three weeks later, she developed breathlessness, with fleeting pulmonary infiltrates on chest radiography, and was treated with plasmaphaeresis with resolution of symptoms.

She was referred to the gastroenterology department with a 2-week history of lower abdominal pain and bloody diarrhoea with urgency and frequency of eight times a day, preceded by 2 months of non-bloody loose stools. Physical examination revealed a sinus tachycardia, low-grade fever and lower abdominal tenderness without guarding. …