A healthy 35-year-old woman bathed in the sea bathing in the East Japan area and then ate grilled chicken skewers. One week later, she visited the family clinic complaining of nausea and had bloody stools. At the time of examination, she had no fever, and no abdominal pain. She had no medical history and took no medications. The most prominent symptom was hematochezia. To confirm the diagnosis, colonoscopy was performed. The colonoscopy findings revealed that multiple white round flat elevations in the reddish intestinal mucosal surface extending longitudinally between the sigmoid colon and rectum, and a diffuse circular elevated lesion in the rectum (Fig. 1a). Image-enhanced endoscopic observations by blue laser emphasized the contours of the ridge edges of circular elevated lesion and the white color of the apex in the rectum (Fig. 1b). Pathological examination revealed mild inflammatory cell infiltration with lymphocyte proliferation into the mucosal stroma, but no specific inflammatory or malignant findings. These findings differ from those of ulcerative colitis. Aeromonas hydrophila was detected in the culture test at the time of endoscopy, and the patient was diagnosed with Aeromonas enterocolitis. The patient complaints were relieved by symptomatic treatment alone.
Figure 1.
(a) There is a diffuse circular elevated lesion in the rectum. (b) Blue laser imaging emphasized the contours of the ridge edges and the white color of the apex.
Aeromonas is a gram-negative rod-shaped bacterium that is widely distributed in rivers, lakes and surrounding soils and seafood [1]. Most Aeromonas enterocolitis patients resolve their diarrhea spontaneously within a week and do not require antibiotics [2, 3]. This case was atypical, with only bloody stools and no abdominal pain or diarrhea.
Endoscopic images of Aeromonas enterocolitis provided in a previous study showed ischemic enterocolitis-like longitudinal ulcers in the sigmoid colon, redness, edema and mucosal roughening [4]. Aeromonas enteritis often resolves spontaneously [1, 5], although depending on the symptoms, fluoroquinolone antibiotics can be used [6]. We consider that the present case has high educational value because endoscopic photographs of Aeromonas enterocolitis are seldom published.
ACKNOWLEDGEMENTS
We thank for the staffs of our endoscopy center, who made important contributions to the success of this study.
Contributor Information
Rion Masaoka, Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan.
Yasumi Katayama, Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan; Endoscopy Center, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan.
Yuto Suzuki, Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan.
Hitoshi Kino, Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan.
Ryo Masaoka, Masaoka Clinic, Chiba City, Japan.
Masaya Tamano, Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan.
CONFLICT OF INTEREST STATEMENT
None declared.
AUTHOR CONTRIBUTIONS
RM collected and analyzed the data, RM and YS treated the patient, YK and HK edited the manuscript and MT proofread the manuscript. All authors read and approved the final version of the manuscript for submission.
FUNDING
There has been no financial support for this work.
ETHICAL APPROVAL
The patients provided their written, informed consent for publication of this report.
CONSENT
The patient provided written, informed consent for publication of this report.
GUARANTOR
Yasumi Katayama MD, PhD.
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