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Virtual case of the month
Fish scale crystals: an under-recognised cause of intestinal necrosis
  1. J M A Bogaerts1,
  2. J G van der Hoeven2,
  3. E E A Arts3,
  4. B M van der Kolk3,
  5. L A Brosens1,4
  1. 1 Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
  2. 2 Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
  3. 3 Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
  4. 4 Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
  1. Correspondence to J M A Bogaerts, Department of Pathology, Radboud University Medical Centre, Nijmegen 6525 GA, The Netherlands; joep.bogaerts{at}radboudumc.nl

https://doi.org/10.1136/jclinpath-2018-205203

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    Clinical question 

    A middle-aged patient with chronic obstructive pulmonary disease (COPD) gold III was admitted to the intensive care unit with an acute, severe exacerbation of COPD. Six days after admission, the patient developed acute kidney injury with hyperkalaemia, for which the patient was treated. Kidney function further deteriorated and after 3 days, continuous venovenous haemofiltration was started. Several days later, a paralytic ileus developed. Subsequently, the patient underwent an exploratory laparotomy, which revealed fibrinous deposits and oedematous, poorly perfused and ischaemic small intestines with two perforations. The resection specimen was submitted for histopathological examination.

    Review the high-quality, interactive digital Aperio slide at http://virtualacp.com/JCPCases/jclinpath-2018-205203/ and consider your diagnosis.

    What is your diagnosis?

    1. Cholestyramine-induced ischaemia.

    2. Idiopathic ischaemia.

    3. Ischaemic enteritis due to vasculitis.

    4. Sevelamer-induced …

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    Footnotes

    • Handling editor Iskander Chaudhry.

    • Contributors Conception and design of study: JMAB, JGvdH, BMvdK, LAB. Acquisition of patient data and literature: JMAB, EEAA, LAB. Analysis and/or interpretation of data and literature: JMAB, EEAA, LAB. Drafting the manuscript: JMAB, LAB. Revising the manuscript critically for important intellectual content: JMAB, JGvdH, EEAA, BMvdK, LAB. Approval of the version of the manuscript to be published: JMAB, JGvdH, EEAA, BMvdK, LAB. All authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing or revision of the manuscript.

    • Competing interests None declared.

    • Patient consent Not required.

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