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Unusual cause of mucosal hemorrhage in caecal pole

A 49yr old gentleman, following a 4-week prodromal illness associated with a lower limbs ulcerative vasculitic-type rash, central abdominal pain, microcytic iron-deficient anaemia (Hb 9.3 g/dL, MCV 69.3 and plasma iron 11 umol/L) and diarrhoea was diagnosed with acute kidney injury secondary to Henoch-Schonlein Purpura (HSP) confirmed by skin and renal biopsy. Despite good symptomatic resolution after 3-months of high-dose steroids, persistence of anaemia with a then uncovered 3-year history of intermittent loose stools culminated in colonoscopy. This showed an otherwise macroscopically normal colon, but acute mucosal haemorrhage from prominent superficial vessels in caecal pole (see Figures 1 and 2). In addition to his established vasculitis, histology findings were consistent with microscopic colitis. He eventually made a complete recovery after a prolonged tapering steroid regimen with a return to normal bowel functioning at 6-months.
Wright Gavin, MS Islam, Basildon & Thurrock University Hospital, Essex, UK, United Kingdom

Unusual cause of mucosal hemorrhage in caecal pole

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