Fish scale crystals: an under recognised cause of intestinal necrosis
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. 1. Cholestyramine induced ischaemia. 2. Idiopathic ischaemia. 3. Ischaemic enteritis due to vasculitis. 4. Sevelamer induced
Journal of Clinical Pathology