Ocrelizumab-Induced Severe Colitis

Table 2

Imaging and procedural results.

Imaging and procedures	Relevant findings
X-ray abdomen	Dilated large bowels with thumbprinting sign
CT abdomen	Pronounced colitis primarily involving the transverse colon, splenic flexure, and descending colon of the large bowel extending to involve the sigmoid colon
Flexible sigmoidoscopy	Decreased mucosa vascular pattern in the sigmoid colon
	Nodular mucosa in the rectosigmoid colon and in the sigmoid colon
	Congested, erythematous, inflamed, and vascular pattern decreased mucosa in the rectum. Histology showed features of biological medication effect.
Laparoscopy converted to open total colectomy	Widespread inflammatory adhesions with contact bleeding. Attempted laparoscopic resection converted to open total colectomy due to disintegrating fulminant colitis of left colon and sigmoid colon falling to pieces on retraction, contact bleeding, and massive distension of large bowel. Frank pus from rectum during insertion of rectal catheter at the end of the case.
Histology of total colectomy	Mucosa in proximal colon appears normal. The rest of the colonic mucosa is completely ulcerated without residual islands of intact mucosa. There is congestion, chronic inflammation, and submucosal fibrosis. The ulceration is mostly superficial but does extend focally to the muscularis propria. Focal areas of subserosal fibrosis are noted. The pathology features are compatible with the clinical diagnosis of medication induced colitis.