Flexible sigmoidoscopy performed by the GI specialists on hospital day 30 showed transmural inflammation (Figure 2), and biopsy returned cryptitis
and crypt abscess consistent with inflammatory bowel disease (IBD) (Figure 3).
Colonoscopic biopsies revealed severe inflammation localized in the submucosa and mucosa histopathologically, cryptitis
and diffuse active colitis with local ulcerations.
Pathological examination revealed focal ulceration, cryptitis
, mixed nflammation at the lamina propria.
The pathologist's review of the specimens revealed that in only 1 patient did the presence of actinomycosis evoke a minor cryptitis
, and in 3 patients there was an associated acute tonsillitis.
Rectal biopsy showed crypt distortion and cryptitis
, with heavy mixed inflammatory cell infiltration (mostly plasma cells and eosinophils) within lamina propria.
Characteristic histologic features include submucosal fibrosis, disruption of the muscularis mucosa, mild inflammation with or without eosinophils, and cryptitis
There may also be a few persistent foci of cryptitis
Ulcerative colitis was diagnosed on the basis of a clinical history of blood and mucus diarrhoea, colonoscopy showing diffuse mucosal oedema, granularity or ulceration at time of diagnosis, and biopsy confirming the presence of crypt branching or deformity along with cryptitis
or crypt abscesses.
Biopsy results showed acute and chronic inflammation with extensive cryptitis
involving the cecum and ascending and sigmoid colon.
Furthermore, apart from surface erosions, there was no evidence of active (neutrophilic) inflammation, such as active cryptitis
, arguing against upper-tract involvement by inflammatory bowel disease.
With the use of new immunomodulatory induction regimens, such as thymoglobulin or alemtuzumab (Campath-1H, Genzyme Corporation, Cambridge, MA), variant histologic features may be associated with ACR (eg, scattered lamina propria neutrophilic or eosinophilic infiltrates and/or cryptitis
associated with early ACR or absence of crypts with intact surface epithelium associated with severe ACR) (Figure 5).
As a result, foci of cryptitis
or erosions in the absence of dysplasia elicit maturation microgradients, that is, transitions from regenerative to mature colonocytes within a single crypt or group of adjoining crypts.