Case 43

 A thirty five-year-old male came to our hospital suffering from intermittent abdominal pain and secretary bloody diarrhea for approximately 2 months. He didn’t have pets. The ingesting history of row cattle meats and row fish was unknown. He had never drunken well water and never been abroad. Body temperature was 36.6°C. No abnormal findings were found except right lower tenderness. Laboratory test revealed white blood cells 11490/mm³, neutophils 79 %, CRP 4.5 mg/dL.
 He consented to receive non-enhanced CT and colonoscopy for further examination (Figs 1- 3).
 Colonoscopy revealed marked multiple white erosions with mucosal edema at ileum from 15 cm oral site to ileum end (Fig. 4). Further, multiple erosions were also found in the entire colon, especially prominent erosions at the Bauhin valve and rectum (Figs 5, 6). Suspicious Crohn’s disease or infectious bowel disease were endoscopically listed. Histological examination revealed infiltration of inflammatory cells and formation of lymphofollicle with swolen lymphnodes. Cultures of biopsy and stool yielded to Yersinia colitis.

What are the possible findings about Yersinia infection ?

a. Ingestion of half-burned pork

b. Latent term: 2 to 5 days

c. Terminal ileitis

d. Initial infection to Peyel’s patches

e. Swollen lymphnodes surrounding cecum and terminal ileum

1.a, b, c 　　 2. b, c, d　　 3. c, d, e 　　 4. a, d, e 　　 5. all

answer

2017.2.22