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Editor’s quiz: GI snapshot
Recurrent intestinal ulcers and perforations complicated with pigmentation
  1. Junfeng Guo1,
  2. Linxi Su2,
  3. Guangsheng Du3,
  4. Yuyang Chen1,
  5. Cheng Liu1,
  6. Bing Wang4,
  7. Yangfan Lv2,
  8. Shiming Yang1,
  9. Xia Xie1
  1. 1 Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, China
  2. 2 Department of Pathology, Xinqiao Hospital, Army Medical University, Chongqing, China
  3. 3 Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
  4. 4 Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, China
  1. Correspondence to Professor Xia Xie, Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, China; xiexia0128{at}163.com; Professor Shiming Yang, Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, China; Yangshiming{at}tmmu.edu.cn

https://doi.org/10.1136/gutjnl-2024-332057

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    Clinical presentation

    A 21-year-old woman presented at our hospital with recurrent fever and abdominal pain. Due to this, the patient has been hospitalised over 100 times. Initially, she was diagnosed with tuberculous peritonitis, yet showed poor response to antituberculosis medication. Besides, exploratory laparotomy at age 5 years revealed no evidence of tuberculosis. Further treatment for Crohn’s disease with infliximab for 6 months also presented no significant improvement. The symptoms persistently recurred with glucocorticoid and immunosuppressive treatment despite momentary relief. One year prior current hospitalisation, the patient endured an acute intestinal perforation, and abdominal pain recurred 3 weeks before. In her family, her elder brother died as a neonate for unknown reasons.

    Large patches of brown pigmentation were examined on her back (figure 1A). Laboratory evaluation revealed notable increases in inflammatory indicators, and haemoglobin was 95 g/L. CT scan and colonoscopy showed extensive intestinal lesions (figure 1B-D). …

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    Footnotes

    • JG, LS and GD are joint first authors.

    • Contributors Data and figures chart extraction: GD. Analysis and interpretation of data: JG, BW and GD. Drafting of the manuscript: JG, YC, YL and CL. Provide pathology slide images and interpretation: LS. Critical revision of the manuscript and obtained funding: SY and XX. XX was responsible for the overall content as guarantor. All authors contributed to the article and approved the submitted version.

    • Funding This work was supported by the Youth Doctoral Talent Incubation Program of Xinqiao Hospital (2022YQB068).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.