{"ops":[{"insert":"A 42-year old woman complains of the intermittent passage of bright red blood per rectum for the last two weeks. There is no associated abdominal pain, nausea, or vomiting.\n\nShe underwent a subtotal colectomy with an ileostomy six months ago, due to fulminant attacks of ulcerative colitis that were refractory to medical treatment.\n\nShe also tested positive for human immunodeficiency virus (HIV) six years ago and has been on regular anti-retroviral therapy ever since. Her last CD4 count, performed two weeks ago, was within normal limits.\n\nThe remainder of the history is unremarkable. A complete blood count (CBC) shows no abnormalities.\n"},{"insert":"\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-S-069_en.png"}},{"insert":"\n"}]}
2
Investigate
Rectal cultures
{"ops":[{"insert":"Normal growth of Bacteroides sp., Enterococcus sp., Escherichia coli, and Enterobacter sp.\n"}]}
Proctoscopy
{"ops":[{"insert":"Granular rectal mucosa with moderate edema. Occasional mucosal erosions with minimal bleeding. No polyps or tumors.\n"}]}
