A 23 year old woman presents with blood and mucus diarrhea, low grade fever, lethargy, and malaise for 1 week. She experienced around 3 to 4 bowel movements daily. She had several such episodes over the last 4 months, which were unsuccessfully treated with multiple courses of antibiotics. She had gone backpacking around South Asia 6 months earlier. An x-ray of her abdomen is found to be normal.
WBC/DC: 8,700/mm3 N: 75% L: 23% Hb: 10.5 g/dl MCV: 88 fl MCH: 31.2 pg MCHC: 30 g/dl Platelets: 517,000/mm3
The tuberculin test is negative.
The mucosa of the rectum and sigmoid colon appear uniformly inflamed, with multiple erosions. There is no contact bleeding. Biopsies show inflammation of the mucosa and submucosa only, with distortion of the crypts, crypt abscesses and lymphoid aggregates.
Appearance: semi solid Pus cells: field full / hpf RBC: field full / hpf No amoeba, ova or cysts identified The stool cultures are negative